Provider Demographics
NPI:1770279622
Name:MASSEY, MCKAY JORDAN (NP)
Entity type:Individual
Prefix:
First Name:MCKAY
Middle Name:JORDAN
Last Name:MASSEY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 E 700 S STE 300
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4086
Mailing Address - Country:US
Mailing Address - Phone:435-673-4644
Mailing Address - Fax:
Practice Address - Street 1:965 E 700 S STE 300
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4086
Practice Address - Country:US
Practice Address - Phone:435-673-4644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8650300-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily