MEDICARE: JESSE DANIEL CARPENTER

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	:	1740148287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSE DANIEL CARPENTER

Provider Business Mailing Address
First Line	:	3074 TIMBERBROOK DR
Second Line	:
City	:	NORTH POLE
State	:	AK
Zip	:	99705-6700
Country	:	US
Telephone Number	:	575-642-8031
Fax Number	:

Provider Business Practice Location Address
First Line	:	3074 TIMBERBROOK DR
Second Line	:
City	:	NORTH POLE
State	:	AK
Zip	:	99705-6700
Country	:	US
Telephone Number	:	575-642-8031
Fax Number	:

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

Provider Enumeration Date	:	01/13/2026
Last Update Date	:	01/13/2026

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Directions to “ JESSE DANIEL CARPENTER ” Practice Location

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