Healthcare Provider Details

I. General information

NPI: 1104739952
Provider Name (Legal Business Name): JABARI KEITH THOMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9139 N DIXIE DR
DAYTON OH
45414-1859
US

IV. Provider business mailing address

9139 N DIXIE DR
DAYTON OH
45414-1859
US

V. Phone/Fax

Practice location:
  • Phone: 937-750-5446
  • Fax:
Mailing address:
  • Phone: 937-750-5446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: