Healthcare Provider Details

I. General information

NPI: 1275932634
Provider Name (Legal Business Name): MACY ANNETTE MASSEY CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MACY ANNETTE BLAIR

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2526 HIGHWAY 65 S STE 203
CLINTON AR
72031-6678
US

IV. Provider business mailing address

PO BOX 9662
CONWAY AR
72033-9662
US

V. Phone/Fax

Practice location:
  • Phone: 501-745-4914
  • Fax: 501-745-6374
Mailing address:
  • Phone: 501-852-1363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberA004179
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: