Healthcare Provider Details

I. General information

NPI: 1477113413
Provider Name (Legal Business Name): JESSICA BISBEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 DRY CREEK RD
FOLSOM CA
95630-6186
US

IV. Provider business mailing address

108 ORANGE BLOSSOM CIR
FOLSOM CA
95630-8115
US

V. Phone/Fax

Practice location:
  • Phone: 916-294-2430
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number3100566A3E
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: