Provider Demographics
NPI:1417518440
Name:MASSEY, CHELSEA DANIELLE
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:DANIELLE
Last Name:MASSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:DANIELLE
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:372 ARBOR POINTE TRL
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-4444
Mailing Address - Country:US
Mailing Address - Phone:423-605-1947
Mailing Address - Fax:
Practice Address - Street 1:2700 EXECUTIVE PARK NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-2770
Practice Address - Country:US
Practice Address - Phone:423-605-1947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26076363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily