Active NPI
Kourtknie Alexis Amillidreem, LMT 3679
- Massage Therapist
- Brandon, MS
National Provider Identifier
1013736628
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- LMT3679
- Practice address
- 1222 Old Fannin Rd Ste D
Brandon, MS 39047-8795 - Phone
- (601) 842-5559
- NPI assigned
- Oct 9, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | LMT3679 | MS | Primary |
Addresses
Primary practice location
1222 Old Fannin Rd Ste D
Brandon, MS 39047-8795
Mailing address
1888 Main St Ste 477
Madison, MS 39110-6337
Phone (601) 842-5559
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LMT3679 | MS | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1728432000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728518400000",
"number": "1013736628",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1888 MAIN ST STE 477",
"city": "MADISON",
"state": "MS",
"postal_code": "391106337",
"telephone_number": "601-842-5559"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1222 OLD FANNIN RD STE D",
"city": "BRANDON",
"state": "MS",
"postal_code": "390478795",
"telephone_number": "601-842-5559"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AMILLIDREEM",
"first_name": "KOURTKNIE",
"middle_name": "ALEXIS",
"credential": "LMT 3679",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-10-09",
"last_updated": "2024-10-10",
"certification_date": "2024-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "MS",
"license": "LMT3679",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brandon, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.