Active NPI
Kimberly Sullivan, LMT
- Massage Therapist
- Jacksonville, FL
National Provider Identifier
1871896142
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA 30055
- Practice address
- 7860 Gate Pkwy Ste 105
Jacksonville, FL 32256-7280 - Phone
- (904) 998-0444
- NPI assigned
- Dec 8, 2010
- Sex
- Female
- Sole proprietor
- Yes
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 | MA 30055 | FL | Primary |
Addresses
Primary practice location
7860 Gate Pkwy Ste 105
Jacksonville, FL 32256-7280
Mailing address
7651 Gate Pkwy Apt 506
Jacksonville, FL 32256-4802
Phone (904) 998-0444
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 |
|---|---|---|---|
| MA 30055 | FL | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1291766400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1291766400000",
"number": "1871896142",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7651 GATE PKWY APT 506",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322564802",
"telephone_number": "904-998-0444"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7860 GATE PKWY STE 105",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322567280",
"telephone_number": "904-998-0444"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "KIMBERLY",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-12-08",
"last_updated": "2010-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "FL",
"license": "MA 30055",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.