Provider Demographics
NPI:1225665193
Name:MASSEY, KAITLIN CRANE (MD)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:CRANE
Last Name:MASSEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SAINT ANN DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3471
Mailing Address - Country:US
Mailing Address - Phone:985-898-4001
Mailing Address - Fax:
Practice Address - Street 1:201 SAINT ANN DR
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3471
Practice Address - Country:US
Practice Address - Phone:985-898-4001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL83967207Q00000X
SC83967390200000X
390200000X
LA338520207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program