Keri Ann Wahwassuck, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MAS-3100 Issued in NU

Practice address

824 17TH Ave S
Nampa, ID 83651-4780

Phone

(208) 724-2050

NPI assigned

Apr 22, 2024

Last updated

Apr 22, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Practice roles

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

• Ideal Health

  dba Modern Chiropractic Center

  • Chiropractor
  • Boise, ID
  • NPI 1811183023
  NPD (past)

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

{
    "created_epoch": "1713744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713744000000",
    "number": "1538914601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 10TH AVE S",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836514556",
            "telephone_number": "208-724-2050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "824 17TH AVE S",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836514780",
            "telephone_number": "208-724-2050"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "206 S Midland Blvd",
            "address_purpose": "LOCATION",
            "city": "Nampa",
            "state": "ID",
            "postal_code": "836862602",
            "country_code": "US",
            "telephone_number": "208-467-1975",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAHWASSUCK",
        "first_name": "KERI",
        "middle_name": "ANN",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-04-22",
        "last_updated": "2024-04-22",
        "certification_date": "2024-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "NU",
            "license": "MAS-3100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine Renee Wade, MASTERS
• Amy Ann Waetje, PHARM D
• Jonathan Stewart Wagner, LPC-MHSP, NCC
• Lynsey Wagner, PT
• Michael Charles Wagner
• Erika Wainaina
• Bonnie Kim Waite, M.D., CHARTERED
• Stacie L Waite, PT
• Wal-Mart Stores, Inc (Vision Center 30-2781)
• Wal-Mart Stores, Inc. (Vision Center 30-3739)

• Massage Therapist in Nampa, ID
• Providers in Nampa, ID by specialty
• Massage Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2024; 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.