Healthcare Provider Details

I. General information

NPI: 1720887375
Provider Name (Legal Business Name): JORDAN ELYSE HEDKE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 1ST ST N
ALABASTER AL
35007-8892
US

IV. Provider business mailing address

118 SHINE DR
PELHAM AL
35124-1513
US

V. Phone/Fax

Practice location:
  • Phone: 205-624-2100
  • Fax:
Mailing address:
  • Phone: 509-572-8462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2557
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: