KOURTKNIE ALEXIS AMILLIDREEM, LMT 3679 — NPI 1013736628 (Licensed & Credentialed Massage Therapist in BRANDON, MS)

CMS-1500 Box 24J / 33a • NPI

1013736628

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

225700000X

Licensed & Credentialed Massage Therapist

Box 32 Service Location & ZIP+4

1222 OLD FANNIN RD STE D, BRANDON, MS, 39047-8795

✓ 9-Digit EDI 837 ZIP+4 (39047-8795)

Practice Phone & Referral Fax

(601) 842-5559

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1013736628 (KOURTKNIE ALEXIS AMILLIDREEM, LMT 3679) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1013736628` (NPI-1 Individual Practitioner)
Provider / Legal Name	KOURTKNIE ALEXIS AMILLIDREEM, LMT 3679
Plain-English Specialty	Licensed & Credentialed Massage Therapist NUCC Code: `225700000X` (Massage Therapist)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	1222 OLD FANNIN RD STE D, BRANDON, MS, 39047-8795
Practice Telephone / Fax	Tel: (601) 842-5559
Administrative Mailing Address	1888 MAIN ST STE 477, MADISON, MS, 39110-6337
Enumeration & Last Sync	Enumerated: 2024-10-09 \| CMS Record Updated: 2024-10-10

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

1222 OLD FANNIN RD STE D, BRANDON, MS, 39047-8795

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Plain-English Taxonomy & CMS Crosswalk (225700000X)

What Does Taxonomy Code 225700000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 225700000X translates to:
"Licensed & Credentialed Massage Therapist"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Massage Therapist for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (KOURTKNIE ALEXIS AMILLIDREEM, LMT 3679)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`225700000X` — Massage Therapist Plain English: Licensed & Credentialed Massage Therapist	State: MS \| License: `LMT3679` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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KOURTKNIE ALEXIS AMILLIDREEM, LMT 3679 (NPI #1013736628)