Provider Demographics
NPI:1952986341
Name:MASSENBURGE, BRETNEY (NP)
Entity Type:Individual
Prefix:
First Name:BRETNEY
Middle Name:
Last Name:MASSENBURGE
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 1:13994 BENT TRL
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75707-4800
Mailing Address - Country:US
Mailing Address - Phone:903-714-0130
Mailing Address - Fax:
Practice Address - Street 1:3159 POINTE NORTH DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-1067
Practice Address - Country:US
Practice Address - Phone:903-714-0130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1027783363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health