Provider Demographics
NPI:1184823676
Name:MASSEY, JOHN R (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:R
Last Name:MASSEY
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 BELUE LANE
Mailing Address - Street 2:SUITE B
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-8299
Mailing Address - Country:US
Mailing Address - Phone:318-251-6385
Mailing Address - Fax:
Practice Address - Street 1:604 BELUE LANE
Practice Address - Street 2:SUITE B
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-5936
Practice Address - Country:US
Practice Address - Phone:318-251-6385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1660364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health