Healthcare Provider Details

I. General information

NPI: 1346546777
Provider Name (Legal Business Name): CYNTHIA B. MASSEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2011
Last Update Date: 11/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14884 HWY 15
DECATUR MS
39327
US

IV. Provider business mailing address

PO BOX 2106
MERIDIAN MS
39302-2106
US

V. Phone/Fax

Practice location:
  • Phone: 601-635-2258
  • Fax: 601-635-2259
Mailing address:
  • Phone: 601-703-4282
  • Fax: 601-703-4597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR850875
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: