Brian Mattingly, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

0810005599 Issued in VA

Practice address

1695 Kernersville Medical Pkwy
Kernersville, NC 27284-7159

Phone

(336) 515-5000

NPI assigned

Mar 7, 2014

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Salisbury Vamc

  • Department of Veterans Affairs (VA) Pharmacy
  • Kernersville, NC
  • NPI 1982652723
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1394150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484092800000",
    "number": "1972929487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "513 GREAT PARK DR",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236082033",
            "telephone_number": "757-871-7773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1695 KERNERSVILLE MEDICAL PKWY",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272847159",
            "telephone_number": "336-515-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTINGLY",
        "first_name": "BRIAN",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-03-07",
        "last_updated": "2017-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810005599",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mirna Darleny Martinez, DO
• Neil Teague Mashburn, PA
• David B Massey, M.D.
• Kathryn Mathews, OTR/L
• Lauren Jump Matthews
• Carrie Beth May, PSYD
• Carmen Christina Mayo, PA-C
• Hannah McBride, BCBA, MS, BA
• Angela M McClung, PA-C
• Paris McCorkle

• All providers in Kernersville, NC
• Clinical Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.