Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Theresa Katherine Mattingly, MD

Individual provider Dermatology Physician · NPI 1265849053

Theresa Katherine Mattingly, MD is a Dermatology in Lees Summit, Missouri. Graduated from Saint Louis University School of Medicine in 2014, 12 years ago. Practices with Advanced Dermatology of Southeast Missouri PC, a 9-clinician group and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
12
Trained at
Saint Louis University School of Medicine
Licensed in
IL
In the registry since
2014
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

3265 NE Ralph Powell Rd
Lees Summit, MO 64064-2301
Phone: (816) 524-4747
Fax: (816) 524-4929
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X · Licence 125064953 (IL)

Record details

NPI number1265849053
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorNo
NPI enumeratedJuly 14, 2014
Last updated in NPPESFebruary 8, 2021
Certification dateFebruary 8, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyDERMATOLOGY
Medical schoolSAINT LOUIS UNIVERSITY SCHOOL OF MEDICINE
Graduated 2014 (12 years in practice)
Group practice Advanced Dermatology Of Southeast Missouri Pc — 9 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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