Most Relevant Information
Provider Data
| NPI Number: | 1003372079 |
| Provider Name: | KATHERINE MICHELLE MATTINGLY PA |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: | 0010-08768 |
Most Important Dates
| Enumeration Date: | 02/14/2019 |
| Last Updated: | 07/16/2024 |
Provider Practice Location
10650 PARK RD
CHARLOTTE
NC
282108538
Practice Location Phone/Fax
| Phone: | 7046673840 |
| Fax: |
Provider Mailing Location
PO BOX 19305
CHARLOTTE
NC
282199305
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |