Provider Demographics
NPI:1982793717
Name:MASSEY, SARAH JANE (FNP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JANE
Last Name:MASSEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 601643
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1643
Mailing Address - Country:US
Mailing Address - Phone:704-358-4400
Mailing Address - Fax:
Practice Address - Street 1:1900 BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1822
Practice Address - Country:US
Practice Address - Phone:704-358-4400
Practice Address - Fax:704-338-6577
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4986P363L00000X
OHNP-09064363L00000X
NC242558363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1991Medicaid
NC1982793717Medicaid
NC7005793Medicaid