Provider Demographics
NPI:1366146680
Name:MASSIE, VONDA DAWN (FNP-BC)
Entity type:Individual
Prefix:
First Name:VONDA
Middle Name:DAWN
Last Name:MASSIE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 MORRIS CIR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-5427
Mailing Address - Country:US
Mailing Address - Phone:727-249-6435
Mailing Address - Fax:
Practice Address - Street 1:504 MCCURDY AVE S # 6
Practice Address - Street 2:
Practice Address - City:RAINSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35986-5254
Practice Address - Country:US
Practice Address - Phone:256-638-9161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-080752363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily