MEDICARE: MS. AUDREY G MASSEY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	1501508	KS
2	363A00000X	Physician Assistant	2011039551	MO

General Provider Information

NPI Number	:	1275804668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AUDREY G MASSEY PA-C

Provider Business Mailing Address
First Line	:	2700 CLAY EDWARDS DR STE 120
Second Line	:
City	:	NORTH KANSAS CITY
State	:	MO
Zip	:	64116-3268
Country	:	US
Telephone Number	:	163-467-4008
Fax Number	:	816-346-7104

Provider Business Practice Location Address
First Line	:	2700 CLAY EDWARDS DR STE 120
Second Line	:
City	:	NORTH KANSAS CITY
State	:	MO
Zip	:	64116-3268
Country	:	US
Telephone Number	:	163-467-4008
Fax Number	:	816-346-7104

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2012
Last Update Date	:	10/01/2020

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