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General NPI Number Information
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NPI Number | 1952793135
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Entity Type | Individual
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Provider Name | MARY KATHRYN MASSARO PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/25/2015
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Last Update Date | 04/11/2017
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Provider Practice Location Address
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Address Line | 1934 ALCOA HWY STE 362
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City | KNOXVILLE
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State | TN
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Zip | 37920-1524
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Country | US
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Telephone | 865-305-4670
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Fax | 865-305-4671
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Provider Business Mailing Address
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Address Line | PO BOX 440445
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City | NASHVILLE
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State | TN
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Zip | 37244-0445
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Country | US
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Telephone | 865-670-6199
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Fax | 865-670-6198
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 2732
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License Number State | TN
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