Individual
AMY L MATTINGLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1800 N CAPITOL AVE, NP E140, INDIANAPOLIS, IN 46202-1218
(317) 962-2894
(317) 963-5285
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28169503A
IN
363L00000X
Nurse Practitioner
71003617A
IN
363LF0000X
Family Nurse Practitioner
Primary
71003617A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000745186
ANTHEM PTAN
IN
05
—
201094930
—
IN
Enumeration date
04/15/2011
Last updated
02/13/2025
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