MR. JEREMY TODD JORDAN (NPI# 1790729614) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790729614 |
| Entity Type | Individual |
| Full Name | MR. JEREMY TODD JORDAN |
| Credential | PA-C |
| Practice Address |
4602 Maccorkle Ave Se Charleston WV 25304-1848 |
| Mailing Address |
415 Morris St Suite 304 Charleston WV 25301-1842 |
| Practice Telephone | 3049254777 |
| Practice Fax Number | 3049254780 |
| Mailing Telephone | 3043887782 |
| Mailing Fax Number | 3043887788 |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2009-07-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 823 | WV | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144436700 | Jeremy Jordan | Occupational Therapist | 1701 Legacy Dr Ste 1475, Frisco, TX 75034-2064 | 2007-05-14 |
| 1124180153 | Jeremy Scott Jordan | Chiropractor | 1235 S Main St, Poplarville, MS 39470-3317 | 2006-12-15 |
| 1235616582 | Jeremy D Jordan | Physical Therapist | 3117 Stillwater Dr, Prescott, AZ 86305-7164 | 2018-07-19 |
| 1952853913 | Jeremy Jordan | Counselor | 4760 Madison Rd, 1st Floor, Cincinnati, OH 45227-1426 | 2016-10-25 |
| 1619364387 | Jeremy Curtis Jordan | Dentist | 300 Hickman Rd, Charlottesville, VA 22911-3554 | 2015-04-21 |
| 1417348905 | Jeremy Dugger Jordan | Registered Nurse | 1600 7th Ave S, Cppi 102, Birmingham, AL 35233-1711 | 2015-02-05 |
| 1902140825 | Jeremy Robert Jordan | Nurse Practitioner | 3400 Spruce St, 6 Silverstein, Philadelphia, PA 19104-4206 | 2012-11-15 |
| 1427345784 | Jeremy Jordan | Physical Therapist | 1705 Delhi St, Lower Level, Dubuque, IA 52001-5900 | 2011-07-06 |
| Street Address |
4602 MACCORKLE AVE SE |
| City | CHARLESTON |
| State | WV |
| Zip Code | 25304-1848 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417945304 | Donald L Seidler | Emergency Medicine | 4602 Maccorkle Ave Se, Charleston, WV 25304-1848 | 2005-10-13 |
| 1841806510 | Ashley Sierra Copen | Social Worker | 4602 Maccorkle Ave Se, Charleston, WV 25304-1848 | 2020-09-18 |
| 1225656044 | Marlee Layh | Student in an Organized Health Care Education/Training Program | 4602 Maccorkle Ave Se, Charleston, WV 25304-1848 | 2020-07-08 |
| 1689040032 | Rocky Lucas | Social Worker | 4602 Maccorkle Ave Se, Charleston, WV 25304-1848 | 2015-08-19 |
| 1861895427 | Cabin Creek Health Center Inc. | Family Medicine | 4602 Maccorkle Ave Se, Charleston, WV 25304-1848 | 2014-09-26 |
| 1750726444 | Wv Rural Healthcare Partnership | Pharmacy | 4602 Maccorkle Ave Se, Charleston, WV 25304-1848 | 2013-05-08 |
| 1588908362 | Cabin Creek Health Center, Inc. | Clinic/Center | 4602 Maccorkle Ave Se, Charleston, WV 25304-1848 | 2012-11-19 |
| 1285988808 | Karen Lynn Bailey | Physician Assistant | 4602 Maccorkle Ave Se, 81 Lincoln Panther Way, Charleston, WV 25304-1848 | 2012-11-05 |
| 1679865687 | Grace Mcclung Falbo | Family Medicine | 4602 Maccorkle Ave Se, Charleston, WV 25304-1848 | 2011-05-09 |
| 1760702120 | Ryan Morrison | Internal Medicine | 4602 Maccorkle Ave Se, Charleston, WV 25304-1848 | 2010-06-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740893908 | Sade Yvonne Rice | Technician | 392 B South Parkd Rd, Charleston, WV 25304 | 2020-08-27 |
| 1053931410 | Pir Ali Shah | Student in an Organized Health Care Education/Training Program | 3200 Maccorkle Avenue Southeast Robert C. Bind Clinical, Charleston, WV 25304 | 2020-04-25 |
| 1649807603 | Jasmine Shah | Student in an Organized Health Care Education/Training Program | 3110 Maccorkle Avenue, Se, Student Services Department - Wvu Building, 4th Floor, Charleston, WV 25304 | 2020-03-26 |
| 1447811872 | Kwasi Amponsah Gambrah | Student in an Organized Health Care Education/Training Program | 3200 Mac Corkle Ave. Se, Robert C. Byrd Clinical Teaching Center, 5th Floor, Charlestoni, WV 25304 | 2019-06-26 |
| 1457916751 | Divya Kalluru | Student in an Organized Health Care Education/Training Program | 3200 Maccorkle Avenue Southeast, Robert C. Bird Clinica, 4th Floor Internal Medicine Department, Charleston, WV 25304 | 2019-05-02 |
| 1841854965 | Sean Michael Percy Losier | Student in an Organized Health Care Education/Training Program | 3200 Maccorkle Ave., Se, Camc Family Medicine Center Robert C. Byrd Clinical Tea, Charleston, WV 25304 | 2019-04-24 |
| 1700440047 | Priyanka Chowdhry | Student in an Organized Health Care Education/Training Program | Robert C. Bird Clinical Training Center, 4th Floor, 3200 Maccorkle Avenue, Southeast, Charleston, WV 25304 | 2019-04-23 |
| 1568925469 | Saranya Dinesan | Student in an Organized Health Care Education/Training Program | 3200 Maccorkle Ave. Se, 4th Floor, Robert C. Byrd Clini, Charleston, WV 25304 | 2019-04-09 |
| 1043771694 | Mary Elizabeth Novak | Student in an Organized Health Care Education/Training Program | Camc Memorial Hospital, Surgicare Center, 3200 Maccorkle Ave Se, Charleston, WV 25304 | 2019-03-27 |
| 1124518600 | Abdullah Sohail | Student in an Organized Health Care Education/Training Program | 4th Floor, 3200 Maccorkle Ave, South East Robert C. Bir, Charleston, WV 25304 | 2018-05-10 |
| Find all providers in zip 25304 | ||||
| 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 |
|---|---|---|---|---|
| 1609475326 | Rebecca Whealen | Physician Assistant | 2026 Huber Rd, Charleston, WV 25314-2236 | 2020-10-23 |
| 1275131054 | Ethan Brody Clontz | Physician Assistant | 1953 Pinehurst Ave, Charleston, SC 29414-6483 | 2020-10-13 |
| 1386251635 | Caitlin Estep | Physician Assistant | 3100 Maccorkle Ave Se Ste 802, Charleston, WV 25304-1233 | 2020-09-29 |
| 1487261509 | Reilly Kilpatrick | Physician Assistant | 1518 Blaze Ln, Charleston, SC 29412-8652 | 2020-09-24 |
| 1083228514 | Andrea Denise Boan | Physician Assistant | 12 Commercial Row Apt A, Charleston, SC 29412-3641 | 2020-09-02 |
| 1194343673 | Andrew N Brewer | Physician Assistant | 171 Ashley Ave Ste 419, Charleston, SC 29425-8908 | 2020-07-10 |
| 1396361309 | Jacquelyn Joseph | Physician Assistant | 134 Howard Mary Dr Apt A, Charleston, SC 29412-9581 | 2020-06-25 |
| 1639719990 | Jessy Marie Hamrick | Physician Assistant | 149 Dutch Rd Apt 105, Charleston, WV 25302-2530 | 2020-01-14 |
| 1093355521 | Virginia Noemi Escobar-cheng | Physician Assistant | 310 Red Mulberry Way Apt 3, Charleston, WV 25306-6395 | 2020-01-13 |
| 1598300279 | Breanne Marie Wiekamp | Physician Assistant | 20 Scarlet Oak Ln Apt 3, Charleston, WV 25306-1128 | 2019-11-17 |
| Find all providers in CHARLESTON | ||||
| City | CHARLESTON |
| Zip Code | 25304 |
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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.