Kyoko Provencio

NPI #1659904514 in Jacksonville, Arkansas

Provider Information

NPI Number: 1659904514
Entity Type: Individual
Name: Kyoko Provencio
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Massage Therapist
Enumeration Date: Feb 19, 2020
Last Updated: Feb 19, 2020

Practice Location

Address: 136 GREGORY PL
City: Jacksonville
State: Arkansas
ZIP Code: 72076-3212
Phone: (501) 412-4536

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Massage Therapist	225700000X	Primary

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