Kelly Broyles-Pederson, LMP

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MA60099597 Issued in WA

Practice address

11 Bellwether Way Suite 102
Bellingham, WA 98225

Phone

(360) 715-1050

NPI assigned

Nov 4, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1288828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328486400000",
    "number": "1508167719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 BELLWETHER WAY SUITE 102",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "98225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 BELLWETHER WAY SUITE 102",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "98225",
            "telephone_number": "360-715-1050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROYLES-PEDERSON",
        "first_name": "KELLY",
        "credential": "LMP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-11-04",
        "last_updated": "2012-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA60099597",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Elise Brown
• Paula L. Brown, L.AC.
• Ryan Tyler Brown, DC
• Shelby Brown
• Joanne Browne
• Steven John Bruce, M.D.
• Holly Brugmann
• Melissa Brulotte, LD
• Brooks Allen Brumfield, M.D.
• Jackie Lynn Brumfield, L.M.P

• Massage Therapist in Bellingham, WA
• Providers in Bellingham, WA by specialty
• Massage Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2012; 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.