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General NPI Number Information
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NPI Number | 1043026685
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Entity Type | Individual
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Provider Name | JORDYN RILEY WALTER PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/09/2024
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 508 STOCKTRAIL AVE
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City | GILLETTE
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State | WY
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Zip | 82716-3582
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Country | US
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Telephone | 307-686-1413
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 20557
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City | BILLINGS
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State | MT
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Zip | 59104-0557
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Country | US
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Telephone | 406-696-3412
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PT1322
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License Number State | WY
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