Provider Demographics
NPI:1790307809
Name:MASSEY, TERESA (BSN)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:MASSEY
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PICKENS
Mailing Address - State:SC
Mailing Address - Zip Code:29671-9349
Mailing Address - Country:US
Mailing Address - Phone:864-419-7964
Mailing Address - Fax:
Practice Address - Street 1:151 SPRING VALLEY RD
Practice Address - Street 2:
Practice Address - City:PICKENS
Practice Address - State:SC
Practice Address - Zip Code:29671-9349
Practice Address - Country:US
Practice Address - Phone:796-486-4419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC233263163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management