Healthcare Provider Details

I. General information

NPI: 1942835079
Provider Name (Legal Business Name): JORDAN SUMMER THOMAS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JORDAN SUMMER PURCELL PA-C

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 POPLAR ST
MURRAY KY
42071-2432
US

IV. Provider business mailing address

1801 DORAN RD S
MURRAY KY
42071-2884
US

V. Phone/Fax

Practice location:
  • Phone: 270-762-1100
  • Fax:
Mailing address:
  • Phone: 618-267-9546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.008717
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3127
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: