Active NPI
Devan Kelso, LMP
- Massage Therapist
- Kent, WA
National Provider Identifier
1467807420
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA 60369798
- Practice address
- 12911 SE Kent Kangley Rd
Kent, WA 98030-7939 - Phone
- (253) 277-0029
- NPI assigned
- Apr 27, 2016
- Sex
- Male
- 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 | MA 60369798 | WA | Primary |
Addresses
Primary practice location
12911 SE Kent Kangley Rd
Kent, WA 98030-7939
Mailing address
PO Box 1451
Auburn, WA 98071-1451
Phone (208) 553-1824
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1296672 | Other | WA | AMTA |
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 |
|---|---|---|---|
| MA 60369798 | WA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1461715200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1461715200000",
"number": "1467807420",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1451",
"city": "AUBURN",
"state": "WA",
"postal_code": "980711451",
"telephone_number": "208-553-1824"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12911 SE KENT KANGLEY RD",
"city": "KENT",
"state": "WA",
"postal_code": "980307939",
"telephone_number": "253-277-0029"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELSO",
"first_name": "DEVAN",
"name_prefix": "Mr.",
"credential": "LMP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-04-27",
"last_updated": "2016-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WA",
"license": "MA 60369798",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMTA",
"identifier": "1296672",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kent, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.