NPI 1124848130

Jessee Dylan Walburn

Practitioner Peer Specialist Stark City, MO

Practice location

Address: 415 South St, Stark City, MO 64866-9627
Phone: (417) 602-9219

Registered specialties

Peer Specialist Primary

Other Service Providers Taxonomy 175T00000X

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Registry record

NPI: 1124848130
Entity type: Individual
Sex (as registered): Male
NPI issued: 14 Oct 2024
Record last updated: 14 Oct 2024

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.