Healthcare Provider Details

I. General information

NPI: 1861304222
Provider Name (Legal Business Name): KENNY CHRISTIANSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 N BEAVER ST BLDG 3
FLAGSTAFF AZ
86001-3147
US

IV. Provider business mailing address

710 N BEAVER ST BLDG 3
FLAGSTAFF AZ
86001-3147
US

V. Phone/Fax

Practice location:
  • Phone: 928-226-1556
  • Fax: 855-821-1779
Mailing address:
  • Phone: 928-226-1556
  • Fax: 855-821-1779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number30539
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: