NPIMap

Organization Active NPI

Jackson Spa LLC

Doing business as Jackson Massage and Day Spa

  • Massage Therapist
  • Jackson, TN
National Provider Identifier
1932089091
Registry record updated Sep 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
Legal business name
JACKSON SPA LLC
Doing business as
Jackson Massage and Day Spa
cryosculpt
Practice address
31 Wiley Parker Rd Ste H
Jackson, TN 38305-5806
NPI assigned
Sep 8, 2025
Last updated
Sep 8, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2025

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

Authorized official

Name
Dr. Kellie Leigh Wallace-Wilding, MDNPI 1063518629
Title
Owner
Phone
(901) 229-1744

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Massage TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225700000X Primary

Addresses

Primary practice location

31 Wiley Parker Rd Ste H
Jackson, TN 38305-5806

Mailing address

31 Wiley Parker Rd Ste H
Jackson, TN 38305-5806

Other names 3

  • Jackson Massage and Day Spa Doing business as
  • cryosculpt Doing business as
  • reke Other name

National Provider Directory

National Provider Directory

Locations

31 Wiley Parker Rd
Ste H
Jackson, TN 38305

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1757289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757289600000",
    "number": "1932089091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 WILEY PARKER RD STE H",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383055806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 WILEY PARKER RD STE H",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383055806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON SPA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-09-08",
        "last_updated": "2025-09-08",
        "certification_date": "2025-09-08",
        "status": "A",
        "authorized_official_last_name": "WALLACE-WILDING",
        "authorized_official_first_name": "KELLIE",
        "authorized_official_middle_name": "LEIGH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "901-229-1744",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson Massage and Day Spa",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "cryosculpt",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "reke",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Jackson, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2025; 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.