Healthcare Provider Details

I. General information

NPI: 1144306549
Provider Name (Legal Business Name): JORDAN E TAYLOR PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JORDAN E MALLOY

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 W PARK PL
COEUR D ALENE ID
83814-2785
US

IV. Provider business mailing address

PO BOX 1387
HAYDEN ID
83835-1387
US

V. Phone/Fax

Practice location:
  • Phone: 208-215-2005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60904961
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberNP729A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: