Active NPI
Traci Anderson, LMT
- Massage Therapist
- Paragould, AR
National Provider Identifier
1962289256
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 9204
- Practice address
- 217B S Pruett St
Paragould, AR 72450-4331 - Phone
- (870) 215-2904
- NPI assigned
- Sep 11, 2023
- 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 | 9204 | AR | Primary |
Addresses
Primary practice location
217B S Pruett St
Paragould, AR 72450-4331
Mailing address
217B S Pruett St
Paragould, AR 72450-4331
Phone (870) 215-2904
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 |
|---|---|---|---|
| 9204 | AR | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1694390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694390400000",
"number": "1962289256",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "217B S PRUETT ST",
"city": "PARAGOULD",
"state": "AR",
"postal_code": "724504331",
"telephone_number": "870-215-2904"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "217B S PRUETT ST",
"city": "PARAGOULD",
"state": "AR",
"postal_code": "724504331",
"telephone_number": "870-215-2904"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "TRACI",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-09-11",
"last_updated": "2023-09-11",
"certification_date": "2023-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "AR",
"license": "9204",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Paragould, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.