Individual
TRINA R. MATTINGLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
417 RIVER DR, IRVINE, KY 40336-1272
(606) 723-0399
(606) 723-0379
Mailing address
PO BOX 936, LONDON, KY 40743-0936
(606) 330-7818
(606) 330-7825
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
3003803
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6400
GROUP MEDICARE #
KY
05
—
78009297
—
KY
05
—
78901261
—
KY
Enumeration date
05/25/2006
Last updated
05/06/2019
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