Active NPI
Kellie Renee Beckman, LMT
- Massage Therapist
- Fond Du Lac, WI
National Provider Identifier
1447918636
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 11602-146
- Practice address
- 82 N Main St Ste 109
Fond Du Lac, WI 54935-3461 - Phone
- (920) 517-6797
- NPI assigned
- Dec 4, 2021
- 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 | 11602-146 | WI | Primary |
Addresses
Primary practice location
82 N Main St Ste 109
Fond Du Lac, WI 54935-3461
Mailing address
105 N Main St Uppr
Fond Du Lac, WI 54935-3459
Phone (920) 517-6797
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 |
|---|---|---|---|
| 11602-146 | WI | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1638576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1638576000000",
"number": "1447918636",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 N MAIN ST UPPR",
"city": "FOND DU LAC",
"state": "WI",
"postal_code": "549353459",
"telephone_number": "920-517-6797"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "82 N MAIN ST STE 109",
"city": "FOND DU LAC",
"state": "WI",
"postal_code": "549353461",
"telephone_number": "920-517-6797"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BECKMAN",
"first_name": "KELLIE",
"middle_name": "RENEE",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-12-04",
"last_updated": "2021-12-04",
"certification_date": "2021-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WI",
"license": "11602-146",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fond Du Lac, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.