Individual
KIM MATTINGLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSL, TSAC-F
Contact information
Practice address
985 BUFFALO LAKE RD, SANFORD, NC 27332-2351
(910) 578-4180
Mailing address
985 BUFFALO LAKE RD, SANFORD, NC 27332-2351
(910) 578-4180
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
001000656
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001000656
NSCA
NC
Enumeration date
01/22/2021
Last updated
01/22/2021
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