Provider Demographics
NPI:1275932634
Name:MASSEY, MACY ANNETTE (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:MACY
Middle Name:ANNETTE
Last Name:MASSEY
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:MACY
Other - Middle Name:ANNETTE
Other - Last Name:BLAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9662
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72033-9662
Mailing Address - Country:US
Mailing Address - Phone:501-852-1363
Mailing Address - Fax:
Practice Address - Street 1:2526 HIGHWAY 65 S STE 203
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031-6678
Practice Address - Country:US
Practice Address - Phone:501-745-4914
Practice Address - Fax:501-745-6374
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004179363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics