Kurt Michael Russell

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

3806 Issued in MS

Practice address

98 Jeff Davis Ave Ste B
Long Beach, MS 39560-6172

Phone

(228) 313-9208

NPI assigned

Jul 15, 2024

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1721001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1053158253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 RYAN CIR",
            "city": "LONG BEACH",
            "state": "MS",
            "postal_code": "395602313",
            "telephone_number": "601-549-4098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "98 JEFF DAVIS AVE STE B",
            "city": "LONG BEACH",
            "state": "MS",
            "postal_code": "395606172",
            "telephone_number": "228-313-9208"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4400 Leisure Time Dr",
            "address_purpose": "LOCATION",
            "city": "Diamondhead",
            "state": "MS",
            "postal_code": "395253237",
            "country_code": "US",
            "telephone_number": "228-363-0695",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "KURT",
        "middle_name": "MICHAEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-07-15",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "MS",
            "license": "3806",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Massage Therapist in Long Beach, MS
• Providers in Long Beach, MS by specialty
• Massage Therapist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 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.

Verify at the official NPI Registry.