Provider Demographics
NPI:1548600919
Name:MASSEY, TARA LYNN
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:LYNN
Last Name:MASSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 N CLEVELAND AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-8387
Mailing Address - Country:US
Mailing Address - Phone:614-818-0300
Mailing Address - Fax:614-818-0313
Practice Address - Street 1:444 N CLEVELAND AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-8387
Practice Address - Country:US
Practice Address - Phone:614-818-0300
Practice Address - Fax:614-818-0313
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA14091NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health