=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326938713
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MATTINGLY FAMILY PRACTICE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2025
-----------------------------------------------------
Last Update Date | 08/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3115 COMMONWEALTH CT STE A3
-----------------------------------------------------
City | OWENSBORO
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42303-4452
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-216-8896
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1919 MOHAWK DR
-----------------------------------------------------
City | OWENSBORO
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42301-4932
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-216-8896
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | APRN/OWNER
-----------------------------------------------------
Name | SKYLAR MATTINGLY
-----------------------------------------------------
Credential | DNP, APRN, FNP-C
-----------------------------------------------------
Telephone | 270-216-8896
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------