=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457152340
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMIE THOMPSON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2025
-----------------------------------------------------
Last Update Date | 03/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4661 INDEPENDENCE AVE N APT 304
-----------------------------------------------------
City | NEW HOPE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55428-4780
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-615-7605
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 945 MARKET ST STE 501
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94103-1701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-442-5885
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171400000X
-----------------------------------------------------
Taxonomy Name | Health & Wellness Coach
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------