Provider Demographics
NPI:1730909615
Name:MATTINGLY, SHEILA WATSON (RN)
Entity type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:WATSON
Last Name:MATTINGLY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:SHEILA
Other - Middle Name:
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN
Mailing Address - Street 1:4384 CLEARWATER WAY STE 190
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-6493
Mailing Address - Country:US
Mailing Address - Phone:859-403-3385
Mailing Address - Fax:
Practice Address - Street 1:4384 CLEARWATER WAY STE 190
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-6493
Practice Address - Country:US
Practice Address - Phone:859-403-3385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1120760163WG0000X, 163WI0500X, 163WS0121X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery