Healthcare Provider Details

I. General information

NPI: 1740148048
Provider Name (Legal Business Name): PROVERBS 12AN1 CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2026
Last Update Date: 01/14/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4865 DUCK CREEK RD
CINCINNATI OH
45227-1421
US

IV. Provider business mailing address

PO BOX 531002
CINCINNATI OH
45253-1002
US

V. Phone/Fax

Practice location:
  • Phone: 937-948-9788
  • Fax:
Mailing address:
  • Phone: 937-948-9788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARTINEZ WILSON
Title or Position: CEO
Credential: ADAPTIVE FITNESS PRO
Phone: 937-948-9788