Individual
THERESA KATHERINE MATTINGLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3265 NE RALPH POWELL RD, LEES SUMMIT, MO 64064-2301
(816) 524-4747
(816) 524-4929
Mailing address
3265 NE RALPH POWELL RD, LEES SUMMIT, MO 64064-2301
(816) 524-4747
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
125064953
IL
Other
Enumeration date
07/14/2014
Last updated
02/08/2021
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