Active NPI
Lynnette J Mattingly, PA-C
- Physician Assistant
- Cave Creek, AZ
National Provider Identifier
1255453346
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1294
- Practice address
- 5128 E Villa Cassandra Way
Cave Creek, AZ 85331-9012 - Phone
- (480) 688-6364
- NPI assigned
- Apr 6, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1294 | AZ | Primary |
Addresses
Primary practice location
5128 E Villa Cassandra Way
Cave Creek, AZ 85331-9012
Mailing address
PO Box 7874
Cave Creek, AZ 85327-7874
Phone (480) 488-1721
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1294 | AZ | MD | Counseling Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175817600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1252540800000",
"number": "1255453346",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 7874",
"city": "CAVE CREEK",
"state": "AZ",
"postal_code": "853277874",
"telephone_number": "480-488-1721"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5128 E VILLA CASSANDRA WAY",
"city": "CAVE CREEK",
"state": "AZ",
"postal_code": "853319012",
"telephone_number": "480-688-6364"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATTINGLY",
"first_name": "LYNNETTE",
"middle_name": "J",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-06",
"last_updated": "2009-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "AZ",
"license": "1294",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cave Creek, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.