Provider Demographics
NPI:1194016816
Name:MASSEY, SONYA DAWNELLE (FNP)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:DAWNELLE
Last Name:MASSEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 LIVE OAK ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402
Mailing Address - Country:US
Mailing Address - Phone:903-455-3500
Mailing Address - Fax:
Practice Address - Street 1:5005 LIVE OAK ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402
Practice Address - Country:US
Practice Address - Phone:903-455-3500
Practice Address - Fax:903-455-3509
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03539363LF0000X
TX2120363LF0000X
TXAP122236363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX263226YL96Medicare PIN