Basic Information
| Provider Information | |||||||||
| NPI: | 1144367566 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MASSE | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | R.N., A.R.N.P | ||||||||
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| Mailing Information | |||||||||
| Address1: | 455 LOVELACEVILLE FLORENCE STA E | ||||||||
| Address2: | |||||||||
| City: | PADUCAH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420033580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2705341284 | ||||||||
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| Practice Location | |||||||||
| Address1: | 225 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | PADUCAH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420037914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2704414500 | ||||||||
| FaxNumber: | 2704414289 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2007 | ||||||||
| LastUpdateDate: | 09/04/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 3000020 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 000000227158 | 01 | KY | ANTHEM | OTHER | 74223199 | 05 | KY | MEDICAID | P01139334 | 01 | KY | RAIL ROAD MEDICARE | OTHER |