Provider Demographics
NPI:1144367566
Name:MASSE, ROBERT P (RN, ARNP)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
Last Name:MASSE
Suffix:
Gender:M
Credentials:RN, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 LOVELACEVILLE FLORENCE STA E
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-3580
Mailing Address - Country:US
Mailing Address - Phone:270-534-1284
Mailing Address - Fax:
Practice Address - Street 1:225 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7914
Practice Address - Country:US
Practice Address - Phone:270-441-4500
Practice Address - Fax:270-441-4289
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3000020367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000227158OtherANTHEM
KY74223199Medicaid
KYP01139334OtherRAIL ROAD MEDICARE
KY74223199Medicaid
KY3321840Medicare ID - Type Unspecified