Healthcare Provider Details

I. General information

NPI: 1407109713
Provider Name (Legal Business Name): KRISTI OGDEN LMY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2012
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1590 WILLOW CREEK RD
PRESCOTT AZ
86301-1164
US

IV. Provider business mailing address

1222 LESLIE ST
PRESCOTT AZ
86301-6681
US

V. Phone/Fax

Practice location:
  • Phone: 928-227-1899
  • Fax:
Mailing address:
  • Phone: 619-504-7005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number5667
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: