Active NPI
Jennifer Nicole Bruner
- Massage Therapist
- Fayetteville, AR
National Provider Identifier
1205712759
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 8803
- Practice address
- 2863 N Old Missouri Rd Ste 112C
Fayetteville, AR 72703-3777 - Phone
- (479) 301-0507
- NPI assigned
- Aug 12, 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 | 8803 | AR | Primary |
Addresses
Primary practice location
2863 N Old Missouri Rd Ste 112C
Fayetteville, AR 72703-3777
Mailing address
28049 Highway 295
Wesley, AR 72773-8700
Phone (479) 236-6434
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 |
|---|---|---|---|
| 8803 | AR | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1754956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1754956800000",
"number": "1205712759",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "28049 HIGHWAY 295",
"city": "WESLEY",
"state": "AR",
"postal_code": "727738700",
"telephone_number": "479-236-6434"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2863 N OLD MISSOURI RD STE 112C",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727033777",
"telephone_number": "479-301-0507"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUNER",
"first_name": "JENNIFER",
"middle_name": "NICOLE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-08-12",
"last_updated": "2025-08-12",
"certification_date": "2025-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "AR",
"license": "8803",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 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.