Individual
KACIE JO MASSEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
401 PHALEN BLVD, SAINT PAUL, MN 55130-5302
(952) 967-7977
(651) 254-8558
Mailing address
8170 33RD AVE, MS 21110Q, BLOOMINGTON, MN 55425-4516
(952) 967-7977
(651) 254-8558
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
12138
MN
363AM0700X
Medical Physician Assistant
12138
MN
Other
Enumeration date
08/24/2016
Last updated
03/18/2019
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