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General NPI Number Information
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NPI Number | 1053074781
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Entity Type | Individual
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Provider Name | KAITLIN JORDAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/19/2021
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Last Update Date | 07/28/2025
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Provider Practice Location Address
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Address Line | 15201 SHADY GROVE RD STE 103
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City | ROCKVILLE
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State | MD
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Zip | 20850-3217
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Country | US
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Telephone | 240-261-6437
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Fax | 240-912-4173
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Provider Business Mailing Address
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Address Line | 932 ORCHARD RIDGE DR UNIT 100
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City | GAITHERSBURG
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State | MD
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Zip | 20878-5887
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Country | US
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Telephone | 901-581-9995
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C0008219
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License Number State | MD
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