Provider Demographics
NPI:1902929532
Name:MASSIE, LIBBY P (APN)
Entity Type:Individual
Prefix:
First Name:LIBBY
Middle Name:P
Last Name:MASSIE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 BROOKSIDE DR
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4627
Mailing Address - Country:US
Mailing Address - Phone:423-857-5907
Mailing Address - Fax:423-857-5904
Practice Address - Street 1:2000 BROOKSIDE DR
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4627
Practice Address - Country:US
Practice Address - Phone:423-857-5907
Practice Address - Fax:423-857-5904
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12660363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3341119Medicaid
TNQ002696Medicaid
VA1902929532Medicaid
TNP00844330OtherRR MEDICARE
NC7000630Medicaid
KY7100112430Medicaid
TNP00844325OtherRR MEDICARE
KY7100112430Medicaid