Individual provider Active NPI

Kirsty Joy Hicks, LMT

  • Massage Therapist
  • Medford, OR
National Provider Identifier
1518486646
Registry record updated Sep 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
23646 Issued in OR
Practice address
820 Crater Lake Ave Ste 113
Medford, OR 97504-6581
Phone
(541) 770-1606
Fax
(541) 770-1606
NPI assigned
Sep 9, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X 23646 OR Primary

Addresses

Primary practice location

820 Crater Lake Ave Ste 113
Medford, OR 97504-6581

Mailing address

4434 Corey Rd
Central Point, OR 97502-9411
Phone (541) 821-3883

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

LicenseStateTypeSpecialty
23646ORMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Epic Wellness NW Massage Therapist Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1504915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1504915200000",
    "number": "1518486646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4434 COREY RD",
            "city": "CENTRAL POINT",
            "state": "OR",
            "postal_code": "975029411",
            "telephone_number": "541-821-3883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 CRATER LAKE AVE STE 113",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975046581",
            "telephone_number": "541-770-1606",
            "fax_number": "541-770-1606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HICKS",
        "first_name": "KIRSTY",
        "middle_name": "JOY",
        "credential": "LMT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-09",
        "last_updated": "2017-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "OR",
            "license": "23646",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2017; 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.