Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 12756A | WY |
NPI | 1043630619 |
---|---|
Provider Name | Krystal J Massey |
First Address | Cheyenne, WY 82009-3446 |
Second Address | Cheyenne, WY 82009-3446 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2014 |
Last Update Date | 11/06/2020 |