Individual
IVY LEE MASSENGALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
923 E CENTRAL AVE, LA FOLLETTE, TN 37766-2768
(423) 907-1200
Mailing address
2305 CRYSTAL SPRING LN, HERMITAGE, TN 37076-4196
(423) 637-2504
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
934
TN
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
09/05/2019
Last updated
12/31/2019
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