Healthcare Provider Details

I. General information

NPI: 1942098660
Provider Name (Legal Business Name): JORDAN KEILAH PARKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2025
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10107 CHERRY LN APT 304
NAMPA ID
83687-1079
US

IV. Provider business mailing address

10107 CHERRY LN APT 304
NAMPA ID
83687-1079
US

V. Phone/Fax

Practice location:
  • Phone: 205-422-1969
  • Fax:
Mailing address:
  • Phone: 205-422-1969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-426805
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: