Active NPI
Jacquelyne Renee Anton, NBC-HWC AND M.S.
- Health & Wellness Coach
- Boise, ID
National Provider Identifier
1720450067
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health & Wellness Coach
- License
- ID-A3435452
- Practice address
- 4100 E Wildhorse LN
Boise, ID 83712-7593 - Phone
- (704) 608-1568
- NPI assigned
- Oct 27, 2015
- Last updated
- Jan 24, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Technician | 247200000X | PSG-055 | ID | |
| Health & Wellness Coach | 171400000X | ID-A3435452 | ID | Primary |
Addresses
Primary practice location
4100 E Wildhorse LN
Boise, ID 83712-7593
Mailing address
4100 E Wildhorse LN
Boise, ID 83712-7593
Phone (704) 608-1568
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ID-A3435452 | ID | MD | Health & Wellness Coach |
| PSG-055 | ID | MD | Other Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1445904000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1642982400000",
"number": "1720450067",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4100 E WILDHORSE LN",
"city": "BOISE",
"state": "ID",
"postal_code": "837127593",
"telephone_number": "704-608-1568"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4100 E WILDHORSE LN",
"city": "BOISE",
"state": "ID",
"postal_code": "837127593",
"telephone_number": "704-608-1568"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANTON",
"first_name": "JACQUELYNE",
"middle_name": "RENEE",
"name_prefix": "Mrs.",
"credential": "NBC-HWC AND M.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-10-27",
"last_updated": "2022-01-24",
"certification_date": "2022-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": "ID",
"license": "PSG-055",
"primary": false
},
{
"code": "171400000X",
"taxonomy_group": "",
"desc": "Health & Wellness Coach",
"state": "ID",
"license": "ID-A3435452",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.