Provider Demographics
NPI:1558802678
Name:MASSEY, RAVEN MECHELLE (NP)
Entity Type:Individual
Prefix:
First Name:RAVEN
Middle Name:MECHELLE
Last Name:MASSEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4937
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841-4937
Mailing Address - Country:US
Mailing Address - Phone:423-286-3400
Mailing Address - Fax:423-286-3402
Practice Address - Street 1:20405 ALBERTA ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841
Practice Address - Country:US
Practice Address - Phone:423-286-3400
Practice Address - Fax:423-286-3402
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-09
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22393363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily