Provider Demographics
NPI:1336446103
Name:MASSEY, EDWARD D (MSN, APN, BC)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:D
Last Name:MASSEY
Suffix:
Gender:M
Credentials:MSN, APN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 FRANKLIN RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-3208
Mailing Address - Country:US
Mailing Address - Phone:615-309-5899
Mailing Address - Fax:
Practice Address - Street 1:278 FRANKLIN RD
Practice Address - Street 2:SUITE 240
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-3208
Practice Address - Country:US
Practice Address - Phone:615-309-5899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6935363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health