Individual
ETHAN MATTINGLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RD
Contact information
Practice address
175 THAD REDMAN RD, PAYNEVILLE, KY 40157-7524
(270) 496-4435
Mailing address
175 THAD REDMAN RD, PAYNEVILLE, KY 40157-7524
(270) 496-4435
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164314
KY
Other
Enumeration date
09/15/2020
Last updated
09/15/2020
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