Provider Demographics
NPI:1497207708
Name:MASSEY-SHARPE, KIA
Entity Type:Individual
Prefix:
First Name:KIA
Middle Name:
Last Name:MASSEY-SHARPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3091 CLARIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-1790
Mailing Address - Country:US
Mailing Address - Phone:215-919-2132
Mailing Address - Fax:
Practice Address - Street 1:3091 CLARIDGE RD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-1790
Practice Address - Country:US
Practice Address - Phone:215-919-2132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016747363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily