Provider Demographics
NPI:1811627136
Name:MATTINGLY, HEATHER LEA
Entity Type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:LEA
Last Name:MATTINGLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 COUNTRYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-2185
Mailing Address - Country:US
Mailing Address - Phone:502-714-9599
Mailing Address - Fax:
Practice Address - Street 1:43 COUNTRYSIDE DR
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-2185
Practice Address - Country:US
Practice Address - Phone:502-714-9599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty