Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kyoko Provencio

Individual provider Massage Therapist · NPI 1659904514

Kyoko Provencio is a Massage Therapist in Jacksonville, Arkansas. Practices as a sole proprietor. Licensed in Arkansas.

Licensed in
AR
In the registry since
2020
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Practice location Address checks out

136 Gregory Pl
Jacksonville, AR 72076-3212
Phone: (501) 412-4536
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Massage Therapist (primary) Taxonomy 225700000X · Licence 7773 (AR)

Record details

NPI number1659904514
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedFebruary 19, 2020
Last updated in NPPESFebruary 19, 2020
Certification dateFebruary 19, 2020
Mailing address136 Gregory Pl, Jacksonville, AR 72076-3212

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