Active NPI
Kaylee Grace Corey, LMT
- Massage Therapist
- Wasilla, AK
National Provider Identifier
1083115950
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 128350
- Practice address
- 1212 W Mystery Ave Ste B
Wasilla, AK 99654 - Phone
- (907) 521-8002
- Fax
- (509) 834-7696
- NPI assigned
- Feb 26, 2018
- Last updated
- Jun 11, 2019
- Sex
- Female
- 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 | 128350 | AK | Primary |
Addresses
Primary practice location
1212 W Mystery Ave Ste B
Wasilla, AK 99654
Mailing address
1212 W Mystery Ave Ste B
Wasilla, AK 99654-6335
Phone (907) 521-8002
Other practice location 1
300 N Main St
Wasilla, AK 99654-7017
Phone (907) 376-8020
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 |
|---|---|---|---|
| 128350 | AK | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alaska Massage Studio LLC | Massage Therapist | Past | Accepting new patients |
| Alaska Massage Studio LLC | Massage Therapist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1519603200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560211200000",
"number": "1083115950",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1212 W MYSTERY AVE STE B",
"city": "WASILLA",
"state": "AK",
"postal_code": "996546335",
"telephone_number": "907-521-8002",
"fax_number": "509-834-7696"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1212 W MYSTERY AVE STE B",
"city": "WASILLA",
"state": "AK",
"postal_code": "99654",
"telephone_number": "907-521-8002",
"fax_number": "509-834-7696"
}
],
"practiceLocations": [
{
"address_1": "300 N Main St",
"address_purpose": "LOCATION",
"city": "Wasilla",
"state": "AK",
"postal_code": "996547017",
"country_code": "US",
"telephone_number": "907-376-8020",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "COREY",
"first_name": "KAYLEE",
"middle_name": "GRACE",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-02-26",
"last_updated": "2019-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "AK",
"license": "128350",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wasilla, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.