Nakita R Jack, LMT
Individual provider Active NPI Massage Therapist · Hayden, ID
NPI 1033865340 · NPPES record last updated Feb 24, 2022
Key facts
- NPI
- 1033865340
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- MAS3883 (ID)
- Practice address
- 9751 N Government Way Ste 4
Hayden, ID 83835-9645 - Phone
- (208) 696-1330
- Fax
- (208) 684-7834
- NPI assigned
- Feb 24, 2022
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MAS3883 | ID | MD | Massage Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MAS3883 | ID | Yes |
Addresses
Primary practice location
9751 N Government Way Ste 4
Hayden, ID 83835-9645
Mailing address
9751 N Government Way Ste 4
Hayden, ID 83835-9645
Phone (208) 696-1330
Other providers in Hayden, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 24, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.