Provider Demographics
NPI:1245776038
Name:MASSEY, MOLLY BALDWIN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:BALDWIN
Last Name:MASSEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MISS
Other - First Name:MOLLY
Other - Middle Name:EMORY
Other - Last Name:BALDWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:12200 IRON BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-1530
Mailing Address - Country:US
Mailing Address - Phone:804-778-4747
Mailing Address - Fax:
Practice Address - Street 1:4917 RICHMOND TAPPAHANNOCK HWY STE 1B
Practice Address - Street 2:
Practice Address - City:AYLETT
Practice Address - State:VA
Practice Address - Zip Code:23009-3416
Practice Address - Country:US
Practice Address - Phone:804-769-1245
Practice Address - Fax:804-769-1342
Is Sole Proprietor?:No
Enumeration Date:2017-01-17
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174406363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily