Provider Demographics
NPI:1174351589
Name:MATTINGLY, FAITH ANN (RN)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:ANN
Last Name:MATTINGLY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3818 GLENSIDE PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-1534
Mailing Address - Country:US
Mailing Address - Phone:502-714-0403
Mailing Address - Fax:
Practice Address - Street 1:3818 GLENSIDE PL
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-1534
Practice Address - Country:US
Practice Address - Phone:502-714-0403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1180654163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice