Healthcare Provider Details

I. General information

NPI: 1245058312
Provider Name (Legal Business Name): JORDAN B PATTERSON APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2024
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MASTER ST
CORBIN KY
40701-3511
US

IV. Provider business mailing address

4700 EXCHANGE CT STE 110
BOCA RATON FL
33431-4450
US

V. Phone/Fax

Practice location:
  • Phone: 606-528-2881
  • Fax: 606-528-0293
Mailing address:
  • Phone: 561-948-0291
  • Fax: 561-859-0429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4028381
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: