Provider Demographics
NPI:1922094903
Name:MASSEY, DAVID A (APRN BC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:A
Last Name:MASSEY
Suffix:
Gender:M
Credentials:APRN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-2637
Mailing Address - Country:US
Mailing Address - Phone:978-270-5069
Mailing Address - Fax:
Practice Address - Street 1:51 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-2637
Practice Address - Country:US
Practice Address - Phone:978-270-5069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN129664363LP0808X
MA236171363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z101120Medicare ID - Type Unspecified
Q22878Medicare UPIN