Organization
ADD CLINIC OF IDAHO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CODY D MATTINGLY PA-C (OWNER)
(858) 207-8861
Entity
Organization
Contact information
Practice address
1450 W USTICK RD, UNIT 102, MERIDIAN, ID 83646
(858) 207-8861
Mailing address
330 W ANTON DR, MERIDIAN, ID 83646-2066
(858) 207-8861
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
09/27/2021
Last updated
09/27/2021
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