Provider Demographics
NPI:1124569553
Name:MASSEY, AMANDA (CRNA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:MASSEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 PIN HOOK DR
Mailing Address - Street 2:
Mailing Address - City:ULYSSES
Mailing Address - State:KY
Mailing Address - Zip Code:41264-9008
Mailing Address - Country:US
Mailing Address - Phone:870-613-7304
Mailing Address - Fax:
Practice Address - Street 1:1099 MEDICAL CENTER CIR
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-1159
Practice Address - Country:US
Practice Address - Phone:270-251-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-18
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011356367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered