MEDICARE: CAROL MASSEY RN, PHN, MSN. PMHNP

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	163W00000X	Registered Nurse	788279	CA
2	163WP0808X	Psychiatric/Mental Health Registered Nurse	788279	CA
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95017619	CA

General Provider Information

NPI Number	:	1386163954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL MASSEY RN, PHN, MSN. PMHNP

Provider Business Mailing Address
First Line	:	25925 NARBONNE AVE UNIT 24
Second Line	:
City	:	LOMITA
State	:	CA
Zip	:	90717-3021
Country	:	US
Telephone Number	:	310-938-5840
Fax Number	:

Provider Business Practice Location Address
First Line	:	5860 UPLANDER WAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90230-6608
Country	:	US
Telephone Number	:	310-966-6500
Fax Number	:

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

Provider Enumeration Date	:	09/14/2017
Last Update Date	:	05/26/2024

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