NPIMap

Individual provider Active NPI

Jackie Wilson, LMT

  • Massage Therapist
  • Denham Springs, LA
National Provider Identifier
1356628325
Registry record updated Nov 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
1169 Issued in LA
Practice address
1019 N Range Ave
Suite B
Denham Springs, LA 70726-2407
Phone
(225) 791-8154
Fax
(225) 791-8152
NPI assigned
Nov 4, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 4, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Reflexologist 173C00000X 1169 LA
Massage Therapist 225700000X 1169 LA Primary

Addresses

Primary practice location

1019 N Range Ave
Suite B
Denham Springs, LA 70726-2407

Mailing address

1019 N Range Ave
Suite B
Denham Springs, LA 70726-2407
Phone (225) 791-8154

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

LicenseStateTypeSpecialty
1169LAMDClinical Social Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1320364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320364800000",
    "number": "1356628325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1019 N RANGE AVE",
            "address_2": "SUITE B",
            "city": "DENHAM SPRINGS",
            "state": "LA",
            "postal_code": "707262407",
            "telephone_number": "225-791-8154",
            "fax_number": "225-791-8152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1019 N RANGE AVE",
            "address_2": "SUITE B",
            "city": "DENHAM SPRINGS",
            "state": "LA",
            "postal_code": "707262407",
            "telephone_number": "225-791-8154",
            "fax_number": "225-791-8152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JACKIE",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-11-04",
        "last_updated": "2011-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "173C00000X",
            "taxonomy_group": "",
            "desc": "Reflexologist",
            "state": "LA",
            "license": "1169",
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "LA",
            "license": "1169",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Denham Springs, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.