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General NPI Number Information
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NPI Number | 1306499199
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Entity Type | Individual
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Provider Name | TERESA MICHELLE MATTINGLY APRN
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Gender | Female
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Dates
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Enumeration Date | 07/20/2019
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 6400 DUTCHMANS PKWY STE 250
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City | LOUISVILLE
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State | KY
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Zip | 40205-3354
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Country | US
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Telephone | 502-587-9660
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Fax |
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Provider Business Mailing Address
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Address Line | 4119 NACHAND LN
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City | LOUISVILLE
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State | KY
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Zip | 40218-2841
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Country | US
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Telephone | 502-439-2396
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 3013645
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License Number State | KY
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