Kimberly S Dedecker - Jamieson, NBC-HWC

Primary specialty

Health & Wellness CoachTaxonomy code 171400000X

License

A-3279539 Issued in TX

Practice address

1649 Royal Oaks CT
Southlake, TX 76092-4049

Phone

(817) 995-6435

Fax

(817) 912-1310

NPI assigned

Nov 4, 2021

Last updated

Jan 28, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1635984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706400000000",
    "number": "1790440667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1649 ROYAL OAKS CT",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760924049",
            "telephone_number": "817-995-6435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1649 ROYAL OAKS CT",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760924049",
            "telephone_number": "817-995-6435",
            "fax_number": "817-912-1310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEDECKER - JAMIESON",
        "first_name": "KIMBERLY",
        "middle_name": "S",
        "credential": "NBC-HWC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-11-04",
        "last_updated": "2024-01-28",
        "certification_date": "2024-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171400000X",
            "taxonomy_group": "",
            "desc": "Health & Wellness Coach",
            "state": "TX",
            "license": "A-3279539",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Cathleen M Delaney, FNP
• Abdier Delgado Gonzalez, MD
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• Health & Wellness Coach in Southlake, TX
• Providers in Southlake, TX by specialty
• Health & Wellness Coach in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.