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Individual
LAURA P MATTINGLY
Active
Individual
LAURA P MATTINGLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA03908
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
183901101
—
TX
05
—
183901102
—
TX
05
—
183901104
—
TX
05
—
385175YS0Q
—
TX
01
—
8245NN
BCBS
TX
01
—
8Y9490
BCBS
TX
01
—
RAILROAD MEDICARE
P01447517
TX
Enumeration date
10/12/2006
Last updated
06/11/2015
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