Individual provider Active NPI

Kristi Enis, PT

  • Physical Therapist
  • Pine Bluff, AR
National Provider Identifier
1710032438
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT2375 Issued in AR
Practice address
2915 S Hazel St
Pine Bluff, AR 71603-5008
Phone
(870) 535-0010
NPI assigned
Jan 24, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT2375 AR Primary

Addresses

Primary practice location

2915 S Hazel St
Pine Bluff, AR 71603-5008

Mailing address

707 Eldridge Ave E
Wynne, AR 72396-4032
Phone (870) 208-8989

Other identifiers 1

IdentifierTypeStateIssuer
5X430OtherARBLUE CROSS & BLUE SHIELD

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
PT2375ARMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Boaz & Associates, Inc. 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": "1169596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1710032438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 ELDRIDGE AVE E",
            "city": "WYNNE",
            "state": "AR",
            "postal_code": "723964032",
            "telephone_number": "870-208-8989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2915 S HAZEL ST",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716035008",
            "telephone_number": "870-535-0010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENIS",
        "first_name": "KRISTI",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-24",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AR",
            "license": "PT2375",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS & BLUE SHIELD",
            "identifier": "5X430",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pine Bluff, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.