Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | MD.33076 | AL |
Y | 207PP0204X | Pediatric Emergency Physician | ME128130 | FL |
NPI | 1659683803 |
---|---|
Provider Name | Dr. Kimberly Lashun Massey |
First Address | Pensacola, FL 32513-2699 |
Second Address | Pensacola, FL 32504-8721 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2010 |
Last Update Date | 25/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
017339500 | (05) | FL |
151555 | (05) | AL |
151556 | (05) | AL |
511-39174 | BCBS (01) | AL |
511-39182 | BCBS (01) | AL |