Provider Demographics
NPI:1750080289
Name:MATTINGLY, SKYLAR LEE (APRN)
Entity type:Individual
Prefix:
First Name:SKYLAR
Middle Name:LEE
Last Name:MATTINGLY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3271 ALVEY PARK DR W STE H
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-2467
Mailing Address - Country:US
Mailing Address - Phone:270-240-2344
Mailing Address - Fax:270-240-2160
Practice Address - Street 1:3271 ALVEY PARK DR W STE H
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-2467
Practice Address - Country:US
Practice Address - Phone:270-240-2344
Practice Address - Fax:270-240-2160
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4025817363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily