Individual
KATHERINE ANN MATTINGLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
122 WYOMING ST, DAYTON, OH 45409-2731
(937) 223-4461
(937) 224-1945
Mailing address
122 WYOMING ST, DAYTON, OH 45409-2731
(937) 223-4461
(937) 224-1945
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50002181
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0067797
—
OH
Enumeration date
07/18/2005
Last updated
01/28/2014
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