Individual
LIBBY P MASSIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
2000 BROOKSIDE DR, THIRD FLOOR, KINGSPORT, TN 37660-4627
(423) 857-5907
(423) 857-5904
Mailing address
2000 BROOKSIDE DR, THIRD FLOOR, KINGSPORT, TN 37660-4627
(423) 857-5907
(423) 857-5904
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
12660
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1902929532
—
VA
05
—
3341119
—
TN
05
—
7000630
—
NC
05
—
7100112430
—
KY
01
—
P00844325
RR MEDICARE
TN
01
—
P00844330
RR MEDICARE
TN
05
—
Q002696
—
TN
Enumeration date
04/09/2007
Last updated
12/18/2014
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