# ADAM R MATTINGLY

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1295836831
- **Gender:** Man
- **Credential:** PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 356 | WY | — |
| 363A00000X | Physician Assistant | 508 | MT | Yes |

## Other

- **Enumeration date:** 09/26/2006
- **Last updated:** 09/26/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000900383 | BCBS PIN | MT |
| 05 | — | 102405100 | — | WY |
| 01 | — | 315012 | BCBS | WY |
| 01 | — | 612315900 | OWCP | WY |