Active NPI
Kristine Jackson, MT
- Massage Therapist
- Blue Jay, CA
National Provider Identifier
1316783137
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 94145
- Practice address
- 27169 California Highway 189,
Suite 2
Blue Jay, CA 92317 - Phone
- (909) 486-9705
- Fax
- (909) 323-0215
- NPI assigned
- Jul 2, 2024
- Last updated
- Jul 2, 2024
- 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 | 94145 | CA | Primary |
Addresses
Primary practice location
27169 California Highway 189,
Suite 2
Blue Jay, CA 92317
Mailing address
PO Box 2392
Lake Arrowhead, CA 92352-2392
Phone (909) 486-9648
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
- Credentials
- Medical Technician
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 94145 | CA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1719878400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719878400000",
"number": "1316783137",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2392",
"city": "LAKE ARROWHEAD",
"state": "CA",
"postal_code": "923522392",
"telephone_number": "909-486-9648"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "27169 CALIFORNIA HIGHWAY 189,",
"address_2": "SUITE 2",
"city": "BLUE JAY",
"state": "CA",
"postal_code": "92317",
"telephone_number": "909-486-9705",
"fax_number": "909-323-0215"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "KRISTINE",
"credential": "MT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-07-02",
"last_updated": "2024-07-02",
"certification_date": "2024-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "CA",
"license": "94145",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Blue Jay, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 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.