Individual
MARY KATHRYN MASSARO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1934 ALCOA HWY, STE 362, KNOXVILLE, TN 37920-1524
(865) 305-4670
(865) 305-4671
Mailing address
PO BOX 440445, NASHVILLE, TN 37244-0445
(865) 670-6199
(865) 670-6198
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
2732
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q013086
—
TN
Enumeration date
02/25/2015
Last updated
04/11/2017
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