Healthcare Provider Details

I. General information

NPI: 1467010744
Provider Name (Legal Business Name): JORDAN JOHN JEPSON PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 DELBON AVE STE 8
TURLOCK CA
95382
US

IV. Provider business mailing address

1000 DELBON AVE STE 8
TURLOCK CA
95382-2008
US

V. Phone/Fax

Practice location:
  • Phone: 209-226-4644
  • Fax:
Mailing address:
  • Phone: 209-226-4644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA56842
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA56842
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: