Jessee Dylan Walburn

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

Practice address

415 South St
Stark City, MO 64866-9627

Phone

(417) 602-9219

NPI assigned

Oct 14, 2024

Last updated

Oct 14, 2024By the provider in NPPES

Sex

Male

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

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

{
    "created_epoch": "1728864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728864000000",
    "number": "1124848130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 SOUTH ST",
            "city": "STARK CITY",
            "state": "MO",
            "postal_code": "648669627",
            "telephone_number": "417-602-9219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 SOUTH ST",
            "city": "STARK CITY",
            "state": "MO",
            "postal_code": "648669627",
            "telephone_number": "417-602-9219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALBURN",
        "first_name": "JESSEE",
        "middle_name": "DYLAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-10-14",
        "last_updated": "2024-10-14",
        "certification_date": "2024-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Peer Specialist in Stark City, MO
• Providers in Stark City, MO by specialty
• Peer Specialist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 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.