Individual
BRAD H MASSEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
AACNP, ANP
Contact information
Practice address
15 KEYSTONE DR STE E, HATTIESBURG, MS 39402-6124
(601) 606-6326
Mailing address
348 KNIGHT ROAD, SUMRALL, MS 39482
(601) 606-6326
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
R814032
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00124846
—
MS
05
—
1582531
—
LA
01
—
640507572PO
AMERICAN ADMIN GROUP
MS
Enumeration date
08/20/2006
Last updated
09/23/2024
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