Provider Demographics
NPI:1861950727
Name:FAULK, JARED WILLIAM
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:WILLIAM
Last Name:FAULK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3561 ASPEN HEIGHTS PKWY APT C
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-7262
Mailing Address - Country:US
Mailing Address - Phone:309-706-0254
Mailing Address - Fax:
Practice Address - Street 1:1222 E WALNUT ST APT 111
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-4972
Practice Address - Country:US
Practice Address - Phone:309-706-0254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program