Kendrah Dawanna Wilson

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MT015102 Issued in GA

Practice address

1709 Osborne Rd Apt Suite
Saint Marys, GA 31558-9141

Phone

(912) 540-0323

NPI assigned

Sep 26, 2024

Last updated

Sep 26, 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 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1727308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727308800000",
    "number": "1902623259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "704 WHEELER ST APT SUITE",
            "city": "SAINT MARYS",
            "state": "GA",
            "postal_code": "315588315",
            "telephone_number": "912-540-0323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1709 OSBORNE RD APT SUITE",
            "city": "SAINT MARYS",
            "state": "GA",
            "postal_code": "315589141",
            "telephone_number": "912-540-0323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KENDRAH",
        "middle_name": "DAWANNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-09-26",
        "last_updated": "2024-09-26",
        "certification_date": "2024-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "FL",
            "license": "MA105415",
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "GA",
            "license": "MT015102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Beth Lowry Wicker, P.T.
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• Alice Williams, LAPC
• Jennifer E Williams
• Amy J Willis, LCSW
• Winston E Dill PHD LLC
• Women of Camden Advanced OBGYN
• Autumn Wood, CF SLP
• Keykee Lee Wright
• Liliana Maria Yepes, APRN

• Massage Therapist in Saint Marys, GA
• Providers in Saint Marys, GA by specialty
• Massage Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 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.