Healthcare Provider Details

I. General information

NPI: 1922842020
Provider Name (Legal Business Name): JOURDAN ALEXIS DAY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 W 12TH ST STE 206
PERU IN
46970-1654
US

IV. Provider business mailing address

240 N TILLOTSON AVE
MUNCIE IN
47304-3988
US

V. Phone/Fax

Practice location:
  • Phone: 765-472-5335
  • Fax: 765-867-6111
Mailing address:
  • Phone: 765-288-1928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10004619A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: