Healthcare Provider Details

I. General information

NPI: 1881458842
Provider Name (Legal Business Name): TRINITY MASSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N 1ST ST STE 4
JACKSONVILLE AR
72076-4139
US

IV. Provider business mailing address

803 W CHILDRESS ST
MORRILTON AR
72110-1815
US

V. Phone/Fax

Practice location:
  • Phone: 501-241-0410
  • Fax:
Mailing address:
  • Phone: 501-504-4226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: