Provider Demographics
NPI:1346670544
Name:MASSEY, JASON
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:MASSEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 BRECKENRIDGE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-1500
Mailing Address - Country:US
Mailing Address - Phone:501-225-2922
Mailing Address - Fax:501-225-3818
Practice Address - Street 1:746 WILBURN RD
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-8902
Practice Address - Country:US
Practice Address - Phone:501-362-7536
Practice Address - Fax:501-362-2343
Is Sole Proprietor?:No
Enumeration Date:2013-11-25
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR597237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR597OtherTHE BOARD OF HEARING INSTRUMENT DISPENSERS