Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | R872528 | MS |
NPI | 1205076809 |
---|---|
Provider Name | Jennifer R Massey |
First Address | Petal, MS 39465-4430 |
Second Address | Hattiesburg, MS 39402-2555 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2009 |
Last Update Date | 23/02/2009 |