Healthcare Provider Details

I. General information

NPI: 1417846742
Provider Name (Legal Business Name): JASON ROBERTSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2908 POSTON AVE
NASHVILLE TN
37203-1309
US

IV. Provider business mailing address

133 TROTWOOD DR
CANONSBURG PA
15317-9783
US

V. Phone/Fax

Practice location:
  • Phone: 866-719-9611
  • Fax:
Mailing address:
  • Phone:
  • 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:
Title or Position:
Credential:
Phone: