Active NPI
Kristen Pack, LMT
- Massage Therapist
- Wasilla, AK
National Provider Identifier
1760023220
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 145079
- Practice address
- 1212 W Mystery Ave
Wasilla, AK 99654-6335 - Phone
- (907) 521-8002
- NPI assigned
- Oct 4, 2019
- Sex
- Female
- Sole proprietor
- No
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 | 145079 | AK | Primary |
Addresses
Primary practice location
1212 W Mystery Ave
Wasilla, AK 99654-6335
Mailing address
PO Box 728
Willow, AK 99688-0728
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 145079 | Other | AK | MASSAGE THERAPIST |
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 |
|---|---|---|---|
| 145079 | AK | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1570147200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1570147200000",
"number": "1760023220",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 728",
"city": "WILLOW",
"state": "AK",
"postal_code": "996880728"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1212 W MYSTERY AVE",
"city": "WASILLA",
"state": "AK",
"postal_code": "996546335",
"telephone_number": "907-521-8002"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PACK",
"first_name": "KRISTEN",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-10-04",
"last_updated": "2019-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "AK",
"license": "145079",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MASSAGE THERAPIST",
"identifier": "145079",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wasilla, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.