Individual
CODY MATTINGLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1475 N COLE RD, BOISE, ID 83704-8537
(208) 809-2880
Mailing address
PO BOX 191050, BOISE, ID 83719-1050
(208) 955-6500
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1677
ID
363AM0700X
Medical Physician Assistant
—
—
Other
Enumeration date
08/03/2018
Last updated
02/25/2021
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