Provider Demographics
NPI:1275804668
Name:MASSEY, AUDREY G (PA-C)
Entity Type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:G
Last Name:MASSEY
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:2700 CLAY EDWARDS DR STE 120
Mailing Address - Street 2:
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3268
Mailing Address - Country:US
Mailing Address - Phone:163-467-4008
Mailing Address - Fax:816-346-7104
Practice Address - Street 1:2700 CLAY EDWARDS DR STE 120
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3268
Practice Address - Country:US
Practice Address - Phone:163-467-4008
Practice Address - Fax:816-346-7104
Is Sole Proprietor?:No
Enumeration Date:2012-01-18
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS1501508363A00000X
MO2011039551363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant