Jay B Old Coyote, PEER SPECIALIST
Individual provider Active NPI Community Health Worker · St Stephens, WY
NPI 1609220706 · NPPES record last updated Apr 15, 2016
Key facts
- NPI
- 1609220706
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Community Health Worker 172V00000X
- Practice address
- #24 Great Plains Road
White Buffalo Recovey Center
St Stephens, WY 82501-0038 - Phone
- (307) 865-0470
- Fax
- (307) 857-4383
- NPI assigned
- Apr 15, 2016
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | Yes |
Addresses
Primary practice location
#24 Great Plains Road
White Buffalo Recovey Center
St Stephens, WY 82501-0038
Mailing address
PO Box 190
#24 Great Plains Road
Riverton, WY 82501-0038
Phone (307) 865-0470
Other providers in St Stephens, WY
All providers in St Stephens, WY · Community Health Worker in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 15, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.