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NPI Code Detail

MEDICARE: PROVERBS 12AN1 CORP.

MEDICARE: PROVERBS 12AN1 CORP.
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
1171400000XHealth & Wellness Coach

General Provider Information

NPI Number : 1740148048
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROVERBS 12AN1 CORP.
Provider Business Mailing Address
First Line : PO BOX 531002
Second Line :
City : CINCINNATI
State : OH
Zip : 45253-1002
Country : US
Telephone Number : 937-948-9788
Fax Number :
Provider Business Practice Location Address
First Line : 4865 DUCK CREEK RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45227-1421
Country : US
Telephone Number : 937-948-9788
Fax Number :
Authorized Official
Title or Position : CEO
Name : MARTINEZ WILSON
Credential : ADAPTIVE FITNESS PRO
Telephone Number : 937-948-9788
Provider Enumeration Date : 01/14/2026
Last Update Date : 01/14/2026

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Directions to “PROVERBS 12AN1 CORP. ” Practice Location

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