Active NPI
William Jernigan III, LMT
- Massage Therapist
- Louisville, KY
National Provider Identifier
1265046247
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 260894
- Practice address
- 1860 Mellwood Ave Ste 179
Louisville, KY 40206-1033 - Phone
- (502) 365-2022
- NPI assigned
- Sep 7, 2020
- 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 | 260894 | KY | Primary |
Addresses
Primary practice location
1860 Mellwood Ave Ste 179
Louisville, KY 40206-1033
Mailing address
8110 Terry Rd
Louisville, KY 40258-1732
Phone (502) 314-9276
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 |
|---|---|---|---|
| 260894 | KY | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1599436800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1599436800000",
"number": "1265046247",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8110 TERRY RD",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402581732",
"telephone_number": "502-314-9276"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1860 MELLWOOD AVE STE 179",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402061033",
"telephone_number": "502-365-2022"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JERNIGAN",
"first_name": "WILLIAM",
"name_prefix": "Mr.",
"name_suffix": "III",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-09-07",
"last_updated": "2020-09-07",
"certification_date": "2020-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "KY",
"license": "260894",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.