Individual
JAY WALKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
41459 S RANGE RD APT 114, PONCHATOULA, LA 70454-3083
(985) 602-7484
Mailing address
41459 S RANGE RD APT 114, PONCHATOULA, LA 70454-3083
(985) 602-7484
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007004123
DRIVER'S LICENSE
LA
Enumeration date
11/29/2017
Last updated
03/20/2020
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