Healthcare Provider Details

I. General information

NPI: 1710712682
Provider Name (Legal Business Name): JORDAN OCHALA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 LINVILLE DR
PARIS KY
40361-2128
US

IV. Provider business mailing address

6 LINVILLE DR
PARIS KY
40361-2128
US

V. Phone/Fax

Practice location:
  • Phone: 859-987-3710
  • Fax: 859-639-1996
Mailing address:
  • Phone: 859-987-3710
  • Fax: 859-639-1996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4024224
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: