Active NPI
Stephanie Jane Brackeen, LMT
- Massage Therapist
- Bella Vista, AR
National Provider Identifier
1366043903
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 031998
- Practice address
- 95 Bassingham Dr
Bella Vista, AR 72715-1526 - Phone
- (760) 421-2303
- NPI assigned
- Nov 2, 2020
- 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 | 031998 | NY | Primary |
Addresses
Primary practice location
95 Bassingham Dr
Bella Vista, AR 72715-1526
Mailing address
95 Bassingham Dr
Bella Vista, AR 72715-1526
Phone (760) 421-2303
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 |
|---|---|---|---|
| 031998 | NY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604275200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604275200000",
"number": "1366043903",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "95 BASSINGHAM DR",
"city": "BELLA VISTA",
"state": "AR",
"postal_code": "727151526",
"telephone_number": "760-421-2303"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "95 BASSINGHAM DR",
"city": "BELLA VISTA",
"state": "AR",
"postal_code": "727151526",
"telephone_number": "760-421-2303"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRACKEEN",
"first_name": "STEPHANIE",
"middle_name": "JANE",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-11-02",
"last_updated": "2020-11-02",
"certification_date": "2020-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "NY",
"license": "031998",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bella Vista, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 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.