Active NPI
Shanette Jackson
- Massage Therapist
- Kenai, AK
National Provider Identifier
1073045050
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 128047
- Practice address
- 602 Frontage Road, Ste.206
Kenai, AK 99611 - Phone
- (907) 416-8276
- NPI assigned
- Mar 30, 2017
- Last updated
- Apr 15, 2025
- 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 | 128047 | AK | Primary |
Addresses
Primary practice location
602 Frontage Road, Ste.206
Kenai, AK 99611
Mailing address
10672 Kenai Spur Hwy Ste 112
Kenai, AK 99611-7868
Phone (907) 513-2467
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 |
|---|---|---|---|
| 128047 | AK | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490832000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1744675200000",
"number": "1073045050",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10672 KENAI SPUR HWY STE 112",
"city": "KENAI",
"state": "AK",
"postal_code": "996117868",
"telephone_number": "907-513-2467"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "602 FRONTAGE ROAD, STE.206",
"city": "KENAI",
"state": "AK",
"postal_code": "99611",
"telephone_number": "907-416-8276"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "SHANETTE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-03-30",
"last_updated": "2025-04-15",
"certification_date": "2025-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "AK",
"license": "128047",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kenai, AK
- Inner Strength Counseling, LLC
- Joan C Itano Merrick, ANP
- Jac Enterprises, Inc. (Charis Place Assisted Living)
- Joann Lee Jackinsky
- Nina Jackson-Catalano
- James W Halliday Jr DMD LLC (Cook Inlet Dental)
- Jennifer Tyler (Pathways Assisted Living Home)
- Carolyn Marie Johnson-Snowder, D.C.
- Amber Michele Johnson, FNP
- Venessa Grace Johnson
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.