JORDAN M EDELEN (NPI# 1851764807) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851764807 |
| Entity Type | Individual |
| Full Name | JORDAN M EDELEN |
| Credential | PAC |
| Practice Address |
908 Dupont Rd Louisville KY 40207-4602 |
| Mailing Address |
100 E Liberty St Suite 800 Louisville KY 40202-1434 |
| Practice Telephone | 5027497909 |
| Practice Fax Number | 5027499397 |
| Mailing Telephone | 5027497909 |
| Mailing Fax Number | 5027499397 |
| Enumeration Date | 2015-11-12 |
| Last Update Date | 2018-03-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA2072 | KY | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | 7100375380 | 05 |
| Street Address |
908 DUPONT RD |
| City | LOUISVILLE |
| State | KY |
| Zip Code | 40207-4602 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982691499 | Thokur Vyas | Emergency Medicine | 908 Dupont Rd, Louisville, KY 40207-4602 | 2005-09-29 |
| 1114533825 | Kevan Patrick Mccullum | Nurse Practitioner | 908 Dupont Rd, Louisville, KY 40207-4602 | 2020-09-17 |
| 1740892165 | Jessica L Lafollette | Nurse Practitioner | 908 Dupont Rd, Louisville, KY 40207-4602 | 2020-08-18 |
| 1376154237 | Danielle Baumgarten | Nurse Practitioner | 908 Dupont Rd, Louisville, KY 40207-4602 | 2020-08-13 |
| 1861002099 | Alycia Marie Green | Registered Nurse | 908 Dupont Rd, Louisville, KY 40207-4602 | 2020-08-03 |
| 1760045181 | Brittney Nicole Ganshirt | Nurse Practitioner | 908 Dupont Rd, Louisville, KY 40207-4602 | 2019-04-22 |
| 1700392404 | Mandy Vittitow | Nurse Practitioner | 908 Dupont Rd, Louisville, KY 40207-4602 | 2017-12-18 |
| 1356861587 | Heather Wingfeld | Physician Assistant | 908 Dupont Rd, Louisville, KY 40207-4602 | 2017-06-20 |
| 1760926273 | Samantha M Slider | Physician Assistant | 908 Dupont Rd, Louisville, KY 40207-4602 | 2016-12-19 |
| 1417499161 | Jennifer Day | Nurse Practitioner | 908 Dupont Rd, Louisville, KY 40207-4602 | 2016-11-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780212688 | Alexia Louise Bodamer | Student in an Organized Health Care Education/Training Program | 142 Chenoweth Lane, Lousiville, KY 40207 | 2020-03-28 |
| 1467918664 | Amy Rock LLC | Counselor | 4010 Dupont Cir Ste 307, Louisville, KY 40207 | 2019-02-13 |
| 1649745191 | Louisville Optometric Center, IIi, Psc | Optometrist | 285 Hubbards Lane, Suite 300, Louisville, KY 40207 | 2018-10-11 |
| 1184137440 | Crimson Dove Counseling Services Inc | Community/Behavioral Health | 214 Breckenridge Ln., Suite 203, Louisville, KY 40207 | 2017-11-09 |
| 1285157586 | Dickerson Family Enterprise, LLC | Non-emergency Medical Transport (VAN) | 4350 Brownsboro Rd., Ste. 110, Louisville, KY 40207 | 2017-07-19 |
| 1578085296 | Cardiovascular Medical Specialists LLC | Surgery | 100 Mallard Creek Rd Ste 150, Louisville, KY 40207 | 2017-07-14 |
| 1932636305 | Devon Turley | Prevention Professional | 1017 Dupont Rd, Suite 1, Louisville, KY 40207 | 2017-05-17 |
| 1285095539 | Emily Schwartz Crouch | Marriage & Family Therapist | 4010 Dupont Circle, Suite 582, Louisville, KY 40207 | 2016-03-15 |
| 1306201280 | A A and Associates Approved Alcohol/drug Program | Counselor | 4006 Dutchmans Lane, Louisville, KY 40207 | 2015-12-21 |
| 1629433693 | Jewish Hospital and St. Mary's Healthcare, Inc. | General Acute Care Hospital | 3290 Dutchmans Lane, Louisville, KY 40207 | 2015-12-17 |
| Find all providers in zip 40207 | ||||
| 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 |
|---|---|---|---|---|
| 1184225591 | Alexis Garrett | Physician Assistant | 16993 Green Crest Ln, Louisville, KY 40245-3217 | 2020-11-03 |
| 1164033353 | Tyler Roberts | Physician Assistant | Private, Louisville, KY 40241 | 2020-08-12 |
| 1184247231 | Jeremiah Noe | Physician Assistant | 3999 Dutchmans Ln Ste 2e, Louisville, KY 40207-4748 | 2020-05-23 |
| 1598388894 | Amanda Marie Hafner | Physician Assistant | 200 E Chestnut St Bldg Suite300, Louisville, KY 40202-1831 | 2020-05-20 |
| 1205487170 | Kenneth D Morrison | Physician Assistant | 9300 Stonestreet Rd Ste 200, Louisville, KY 40272-2894 | 2019-09-23 |
| 1518515444 | William Wilson | Physician Assistant | 1037 E Caldwell St, Louisville, KY 40204-1857 | 2019-09-04 |
| 1760955546 | Benjamin Charles Askins | Physician Assistant | 7906 New La Grange Rd, Louisville, KY 40222-4718 | 2019-01-04 |
| 1770066292 | Molly Roberson Comprehensive Surgical Assistance Pllc | Physician Assistant | 1064 Eastern Pkwy, Louisville, KY 40217-1532 | 2018-09-11 |
| 1598246860 | Kelsi J Barnes | Physician Assistant | 13151 Magisterial Dr # 200, Louisville, KY 40223-4103 | 2018-08-24 |
| 1174009930 | Faun Ellwood-digel | Physician Assistant | 275 W Walnut St, Louisville, CO 80027-2295 | 2018-07-16 |
| Find all providers in LOUISVILLE | ||||
| City | LOUISVILLE |
| Zip Code | 40207 |
Please comment or provide details below to improve the information on JORDAN M EDELEN.
| 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.