MEDICARE: MRS. JORDAN BLANCHARD MYERS PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	307200	LA
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1841714193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JORDAN BLANCHARD MYERS PA-C

Provider Business Mailing Address
First Line	:	2509 MAPLEWOOD DR
Second Line	:
City	:	SULPHUR
State	:	LA
Zip	:	70663-6105
Country	:	US
Telephone Number	:	337-625-0341
Fax Number	:

Provider Business Practice Location Address
First Line	:	2509 MAPLEWOOD DR
Second Line	:
City	:	SULPHUR
State	:	LA
Zip	:	70663-6105
Country	:	US
Telephone Number	:	337-624-0341
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2017
Last Update Date	:	02/27/2024

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