Healthcare Provider Details

I. General information

NPI: 1790307809
Provider Name (Legal Business Name): TERESA MASSEY BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 05/12/2020
Certification Date: 05/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 SPRING VALLEY RD
PICKENS SC
29671-9349
US

IV. Provider business mailing address

151 SPRING VALLEY RD
PICKENS SC
29671-9349
US

V. Phone/Fax

Practice location:
  • Phone: 796-486-4419
  • Fax:
Mailing address:
  • Phone: 864-419-7964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number233263
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: