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General NPI Number Information
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NPI Number | 1194347765
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Entity Type | Individual
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Provider Name | KARA JORDAN FREEMAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/17/2020
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Last Update Date | 10/26/2022
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Provider Practice Location Address
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Address Line | 830 S 6TH ST
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City | TERRE HAUTE
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State | IN
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Zip | 47807-4712
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Country | US
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Telephone | 812-213-8080
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Fax |
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Provider Business Mailing Address
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Address Line | 7911 MICHIGAN RD
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City | INDIANAPOLIS
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State | IN
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Zip | 46268-1915
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Country | US
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Telephone | 901-283-0956
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10003131A
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License Number State | IN
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