Healthcare Provider Details

I. General information

NPI: 1538643978
Provider Name (Legal Business Name): JORDAN MATTHEW MCNEIL PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2018
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1054 CENTER DR STE 2
RICHMOND KY
40475-3851
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 859-625-5242
  • Fax: 859-625-5279
Mailing address:
  • Phone: 606-330-7835
  • Fax: 606-330-7825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2654
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2654
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: