Basic Information
| Provider Information | |||||||||
| NPI: | 1346546777 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MASSEY | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | B. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2106 | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | MS | ||||||||
| PostalCode: | 393022106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6017034282 | ||||||||
| FaxNumber: | 6017034597 | ||||||||
| Practice Location | |||||||||
| Address1: | 14884 HWY 15 | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016352258 | ||||||||
| FaxNumber: | 6016352259 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2011 | ||||||||
| LastUpdateDate: | 11/07/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | R850875 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 00604803 | 05 | MS | MEDICAID |