Individual
JARED WILLIAM FAULK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1222 E WALNUT ST APT 111, COLUMBIA, MO 65201-4972
(309) 706-0254
Mailing address
3561 ASPEN HEIGHTS PKWY APT C, COLUMBIA, MO 65201-7262
(309) 706-0254
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/08/2019
Last updated
08/11/2021
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