Active NPI
Ke'Andre Stevenson, LMBT
- Massage Therapist
- Winston Salem, NC
National Provider Identifier
1033956735
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 16469
- Practice address
- 1 Medical Center Blvd
Winston Salem, NC 27157-0001 - Phone
- (336) 713-3088
- NPI assigned
- Jul 10, 2024
- Last updated
- Jul 10, 2024
- Sex
- Male
- Sole proprietor
- No
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 | 16469 | NC | Primary |
Addresses
Primary practice location
1 Medical Center Blvd
Winston Salem, NC 27157-0001
Mailing address
1 Medical Center Blvd
Winston Salem, NC 27157-0001
Phone (336) 713-3088
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 |
|---|---|---|---|
| 16469 | NC | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1720569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1720569600000",
"number": "1033956735",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 MEDICAL CENTER BLVD",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271570001",
"telephone_number": "336-713-3088"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 MEDICAL CENTER BLVD",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271570001",
"telephone_number": "336-713-3088"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEVENSON",
"first_name": "KE'ANDRE",
"credential": "LMBT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-07-10",
"last_updated": "2024-07-10",
"certification_date": "2024-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "NC",
"license": "16469",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winston Salem, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 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.