Healthcare Provider Details

I. General information

NPI: 1306369863
Provider Name (Legal Business Name): JAMIE E JORDAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE E SHELTON PA-C

II. Dates (important events)

Enumeration Date: 07/17/2017
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 HARRODSBURG RD
LEXINGTON KY
40504-3751
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 859-276-4429
  • Fax: 859-276-5902
Mailing address:
  • Phone: 606-330-7835
  • Fax: 859-276-5902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: