Active NPI
Kimberly Renee Ellis, MT
- Massage Therapist
- Bowling Green, KY
National Provider Identifier
1841368313
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 0062
- Practice address
- 1110 Wilkinson Trce
Bowling Green, KY 42103-3402 - Phone
- (270) 796-6850
- Fax
- (270) 781-8228
- NPI assigned
- Dec 1, 2006
- 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 | 0062 | KY | Primary |
Addresses
Primary practice location
1110 Wilkinson Trce
Bowling Green, KY 42103-3402
Mailing address
PO Box 641268
Cincinnati, OH 45264-0304
Phone (270) 745-1120
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760411342 | Other | KY | NPI GROUP |
| GROUP #91011148 | Medicaid | KY |
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
- Credentials
- Medical Technician
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0062 | KY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1841368313",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 641268",
"city": "CINCINNATI",
"state": "OH",
"postal_code": "452640304",
"telephone_number": "270-745-1120",
"fax_number": "270-745-1156"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1110 WILKINSON TRCE",
"city": "BOWLING GREEN",
"state": "KY",
"postal_code": "421033402",
"telephone_number": "270-796-6850",
"fax_number": "270-781-8228"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "KIMBERLY",
"middle_name": "RENEE",
"credential": "MT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "KY",
"license": "0062",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI GROUP",
"identifier": "1760411342",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GROUP #91011148",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bowling Green, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.