Provider Demographics
NPI:1447574983
Name:MASSEY, KIMBERLY (FNP-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:MASSEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 ANSLEY DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-1639
Mailing Address - Country:US
Mailing Address - Phone:706-864-8608
Mailing Address - Fax:706-864-8610
Practice Address - Street 1:134 ANSLEY DR
Practice Address - Street 2:SUITE 400
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-1639
Practice Address - Country:US
Practice Address - Phone:706-864-8608
Practice Address - Fax:706-864-8610
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN164613363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner