JORDAN WILSON (NPI# 1235651720) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235651720 |
| Entity Type | Individual |
| Full Name | JORDAN WILSON |
| Credential | PA-C |
| Practice Address |
2428 W Reynolds Ave Centralia WA 98531 |
| Mailing Address |
123 4th Ave W Apt 702 Olympia WA 98501-1052 |
| Practice Telephone | 3603309044 |
| Mailing Telephone | 6306052703 |
| Enumeration Date | 2017-07-17 |
| Last Update Date | 2018-09-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA60855409 | WA | Physician Assistants & Advanced Practice Nursing Providers |
| N | 2084B0040X |
Psychiatry & Neurology Specialization: Behavioral Neurology & Neuropsychiatry |
9110440 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 2101119 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3469 N Dixie Hwy, Oakland Park, FL 333342872 | 3059124323 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962914341 | Jordan Wilson | Dietitian, Registered | 2075 E Flamingo Rd -southmagna, Room242, Las Vegas, NV 89119-5188 | 2017-10-25 |
| 1265951610 | Jordan Elisabeth Wilson | Behavior Technician | 1114 Main St Apt A, Danville, VA 24541-2954 | 2017-09-18 |
| 1568060879 | Jordan Leigh Wilson | Behavior Technician | 3012 E Hebron Pkwy Ste 118, Carrollton, TX 75010-4461 | 2020-10-09 |
| 1962041095 | Jordan Wilson | Case Manager/Care Coordinator | 3800 Watt Ave, Sacramento, CA 95821-2670 | 2020-01-07 |
| 1235775263 | Jordan Wilson | Pharmacist | 8745 S Emerson Ave, Indianapolis, IN 46237-9400 | 2019-11-25 |
| 1609346030 | Jordan Wilson | Counselor | 9330 59th Ave Sw, Lakewood, WA 98499-2858 | 2018-11-28 |
| 1508344037 | Jordan Wood Wilson | Physician Assistant | 1515 Holcombe Blvd, Houston, TX 77030 | 2018-08-06 |
| 1578073821 | Jordan Wilson | Psychologist | 8140 Ashton Ave, Suite 200, Manassas, VA 20109 | 2017-10-01 |
| 1710295951 | Jordan Nicole Wilson | Physical Therapy Assistant | 111 E Washington St, Bensenville, IL 60106-2674 | 2010-09-22 |
| Street Address |
2428 W REYNOLDS AVE |
| City | CENTRALIA |
| State | WA |
| Zip Code | 98531 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427156520 | Dwayne Allen Kruse | Counselor | 2428 W Reynolds Ave, Centralia, WA 98531-4554 | 2006-09-20 |
| 1447857172 | Aurora Cecelia Beck | Peer Specialist | 2428 W Reynolds Ave, Centralia, WA 98531-4554 | 2020-10-06 |
| 1447857180 | Kristina Chavez | Peer Specialist | 2428 W Reynolds Ave, Centralia, WA 98531-4554 | 2020-10-06 |
| 1518564251 | Alyssa Logan | Counselor | 2428 W Reynolds Ave, Centralia, WA 98531-4554 | 2020-10-06 |
| 1659985117 | Dakota E Carucci | Counselor | 2428 W Reynolds Ave, Centralia, WA 98531-4554 | 2020-09-02 |
| 1639789381 | Lindsay Baker | Peer Specialist | 2428 W Reynolds Ave, Centralia, WA 98531-4554 | 2020-08-07 |
| 1184234064 | Brent Garrett Erwin | Peer Specialist | 2428 W Reynolds Ave, Centralia, WA 98531-4554 | 2020-08-05 |
| 1245848589 | Falisha Irene Bazemore | Peer Specialist | 2428 W Reynolds Ave, Centralia, WA 98531-4554 | 2020-07-22 |
| 1376161273 | Bronson Makoa Lee | Counselor | 2428 W Reynolds Ave, Centralia, WA 98531-4554 | 2020-07-08 |
| 1063038966 | Amber Shay Kesgard | Counselor | 2428 W Reynolds Ave, Centralia, WA 98531-4554 | 2020-06-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306462205 | Jelisa Renae Thomas | Counselor | 3510 Steelhammer Ln, Centralia, WA 98531 | 2020-06-17 |
| 1205498607 | Jennifer Kristine Mcglynn Paterno | Counselor | 2428 W. Reynods Ave, Centralia, WA 98531 | 2019-07-05 |
| 1538646328 | Adam Jeffrey Moore | Counselor | 3510 Steelhammer Lane, Centralia, WA 98531 | 2018-07-24 |
| 1144706698 | Euijeong Kim | Occupational Therapist | Rehabilitation Therapies, 914 S. Scheuber Rd, Centralia, WA 98531 | 2018-07-18 |
| 1104315266 | Margaret Fowler Floyd | Registered Nurse | Centralia High School, 813 Eshom Road, Centralia, WA 98531 | 2018-05-04 |
| 1124545777 | Samantha Michelle Moody | Speech-Language Pathologist | Centralia School District, 2320 Borst Ave, Centralia, WA 98531 | 2017-08-24 |
| 1821520289 | Alexa Franks | Behavior Technician | 2428 West Reynolds Ave., Centralia, WA 98531 | 2017-04-03 |
| 1023559861 | Brandy Michelle Peterson | Counselor | 135 W. Main Steet, Centralia, WA 98531 | 2017-03-13 |
| 1841738812 | Graceful Healing Naturopathic | Naturopath | 219 N Tower Ave, Suite 304, Centralia, WA 98531 | 2017-02-09 |
| 1043681513 | Angela Naillon | Counselor | 2428 West Reynolds, Centralia, WA 98531 | 2015-10-09 |
| Find all providers in zip 98531 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356392245 | Karen Diane Hummel | Physician Assistant | 1011 W Broadway, Centralia, IL 62801-5309 | 2006-05-15 |
| 1710937305 | Heather Cushing | Physician Assistant | 1900 Cooks Hill Rd, Centralia, WA 98531-9073 | 2006-05-12 |
| 1942201330 | Herbert James Huston | Physician Assistant | 404 N Pleasant Ave, Centralia, IL 62801-3006 | 2005-08-09 |
| 1255963880 | Abigail Victoria Reed | Physician Assistant | 1720 Cooks Hill Rd, Centralia, WA 98531-9071 | 2020-02-11 |
| 1982269395 | Jennifer Green | Physician Assistant | 914 S Scheuber Rd, Centralia, WA 98531-9027 | 2019-05-01 |
| 1033698519 | Jennifer Ann Reuter | Physician Assistant | 914 S Scheuber Rd, Centralia, WA 98531 | 2018-08-07 |
| 1285143933 | Lukas Wesley Steffan | Physician Assistant | 1900 Cooks Hill Rd, Centralia, WA 98531-9073 | 2017-09-26 |
| 1780102970 | Mercedes Longton Converse | Physician Assistant | 914 S Scheuber Rd, Centralia, WA 98531-9027 | 2017-09-07 |
| 1417496183 | Jessica Kathleen Hannigan | Physician Assistant | 1900 Cooks Hill Rd, Centralia, WA 98531-9073 | 2017-02-14 |
| 1154872786 | Christopher Michael Jones | Physician Assistant | 914 S Scheuber Rd, Centralia, WA 98531-9027 | 2016-10-19 |
| Find all providers in CENTRALIA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.