Individual
JAY B OLD COYOTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PEER SPECIALIST
Contact information
Practice address
#24 GREAT PLAINS ROAD, WHITE BUFFALO RECOVEY CENTER, ST STEPHENS, WY 82501-0038
(307) 865-0470
(307) 857-4383
Mailing address
PO BOX 190, #24 GREAT PLAINS ROAD, RIVERTON, WY 82501-0038
(307) 865-0470
(307) 857-4383
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
04/15/2016
Last updated
04/15/2016
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