Provider Demographics
NPI:1023338852
Name:WALKER, JESSE BRIGHT (LAC, LMBT)
Entity type:Individual
Prefix:MRS
First Name:JESSE
Middle Name:BRIGHT
Last Name:WALKER
Suffix:
Gender:F
Credentials:LAC, LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4813
Mailing Address - Street 2:
Mailing Address - City:EMERALD ISLE
Mailing Address - State:NC
Mailing Address - Zip Code:28594-4813
Mailing Address - Country:US
Mailing Address - Phone:252-354-7672
Mailing Address - Fax:
Practice Address - Street 1:10502 COAST GUARD ROAD
Practice Address - Street 2:
Practice Address - City:EMERALD ISLE
Practice Address - State:NC
Practice Address - Zip Code:28594
Practice Address - Country:US
Practice Address - Phone:252-354-7672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC240171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist