Provider Demographics
NPI:1144355744
Name:MATTINGLY, APRIL RENEE (MD)
Entity type:Individual
Prefix:DR
First Name:APRIL
Middle Name:RENEE
Last Name:MATTINGLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:7926 PRESTON HWY
Practice Address - Street 2:SUITE 210
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-3848
Practice Address - Country:US
Practice Address - Phone:502-371-0022
Practice Address - Fax:502-394-3620
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY41600208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200907180Medicaid
KY7100044430Medicaid
KY41600OtherKENTUCKY MEDICAL LICENSE
KY000001008779OtherANTHEM
KY049330OtherSIHO
KY50103506OtherPASSPORT
KY000001008779OtherANTHEM
KY41600OtherKENTUCKY MEDICAL LICENSE