MEDICARE: MR. RICHARD ALAN JETT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1093496572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD ALAN JETT

Provider Business Mailing Address
First Line	:	6039 SW GRAND OAKS DR
Second Line	:
City	:	CORVALLIS
State	:	OR
Zip	:	97333-3958
Country	:	US
Telephone Number	:	541-659-9456
Fax Number	:

Provider Business Practice Location Address
First Line	:	6039 SW GRAND OAKS DR
Second Line	:
City	:	CORVALLIS
State	:	OR
Zip	:	97333-3958
Country	:	US
Telephone Number	:	541-659-9456
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2023
Last Update Date	:	07/27/2023

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Directions to “ MR. RICHARD ALAN JETT ” Practice Location

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