Candice Erickson
Individual provider Active NPI Massage Therapist · Winfield, MO
NPI 1386426591 · NPPES record last updated Oct 23, 2023
Key facts
- NPI
- 1386426591
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- 2022009873 (MO)
- Practice address
- 9 Cedar CV
Winfield, MO 63389-3051 - Phone
- (612) 237-5077
- NPI assigned
- Oct 23, 2023
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2022009873 | MO | MD | Massage Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 2022009873 | MO | Yes |
Addresses
Primary practice location
9 Cedar CV
Winfield, MO 63389-3051
Mailing address
9 Cedar CV
Winfield, MO 63389-3051
Phone (612) 237-5077
NPI Registry JSON
{
"created_epoch": "1698019200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1698019200000",
"number": "1386426591",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9 CEDAR CV",
"city": "WINFIELD",
"state": "MO",
"postal_code": "633893051",
"telephone_number": "612-237-5077"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9 CEDAR CV",
"city": "WINFIELD",
"state": "MO",
"postal_code": "633893051",
"telephone_number": "612-237-5077"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ERICKSON",
"first_name": "CANDICE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-10-23",
"last_updated": "2023-10-23",
"certification_date": "2023-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "MO",
"license": "2022009873",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 23, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.