Provider Demographics
NPI:1558677682
Name:MASSIE, JODI ANN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:ANN
Last Name:MASSIE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MISS
Other - First Name:JODI
Other - Middle Name:ANN
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:502 N VALLEY PKWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3437
Mailing Address - Country:US
Mailing Address - Phone:972-353-8616
Mailing Address - Fax:972-353-5352
Practice Address - Street 1:502 N VALLEY PKWY
Practice Address - Street 2:SUITE 1
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3437
Practice Address - Country:US
Practice Address - Phone:972-353-8616
Practice Address - Fax:972-353-5352
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX534030363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily