MEDICARE: MACY ANNETTE MASSEY CPNP-PC

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	363LP0200X	Pediatric Nurse Practitioner	A004179	AR

General Provider Information

NPI Number	:	1275932634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACY ANNETTE MASSEY CPNP-PC

Provider Business Mailing Address
First Line	:	PO BOX 9662
Second Line	:
City	:	CONWAY
State	:	AR
Zip	:	72033-9662
Country	:	US
Telephone Number	:	501-852-1363
Fax Number	:

Provider Business Practice Location Address
First Line	:	2526 HIGHWAY 65 S STE 203
Second Line	:
City	:	CLINTON
State	:	AR
Zip	:	72031-6678
Country	:	US
Telephone Number	:	501-745-4914
Fax Number	:	501-745-6374

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

Provider Enumeration Date	:	08/21/2014
Last Update Date	:	02/01/2024

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Directions to “ MACY ANNETTE MASSEY CPNP-PC” Practice Location

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