1033666276 NPI number — MRS. NICOLE BAEKEY MASSEY CRNP

Table of content: MRS. NICOLE BAEKEY MASSEY CRNP (NPI 1033666276)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033666276 NPI number — MRS. NICOLE BAEKEY MASSEY CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MASSEY
Provider First Name:
NICOLE
Provider Middle Name:
BAEKEY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAEKEY
Provider Other First Name:
NICOLE
Provider Other Middle Name:
CHRISTA
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033666276
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
833 SAINT VINCENTS DR POB III
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35205-1606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-933-4640
Provider Business Mailing Address Fax Number:
205-939-4519

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
833 ST VINCENT'S DRIVE
Provider Second Line Business Practice Location Address:
POB III SUITE 300
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35205-3520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-933-4640
Provider Business Practice Location Address Fax Number:
205-939-4519
Provider Enumeration Date:
09/06/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  1-123579 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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