NPI Code Detail JSON Logo

1740159060 NPI number — BLAKE NELSON JORDAN PA-C

NPI Number: 1740159060
Health Care Provider/Practitioner: BLAKE NELSON JORDAN PA-C

Information about “1740159060” NPI (BLAKE NELSON JORDAN PA-C) exists in 1740159060 in HTML format HTML  |  1740159060 in plain Text format TXT  |  1740159060 in PDF (Portable Document Format) PDF  |  1740159060 in an XML format XML  formats.

NPI Number : 1740159060 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1740159060",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JORDAN",
    "FirstName": "BLAKE",
    "MiddleName": "NELSON",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "892 S 30 E",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SALEM",
    "MailingAddressStateName": "UT",
    "MailingAddressPostalCode": "84653-5305",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "435-227-6263",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1784 UINTA WAY STE E",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PARK CITY",
    "PracticeLocationAddressStateName": "UT",
    "PracticeLocationAddressPostalCode": "84098-7669",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "435-604-0160",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/04/2025",
    "LastUpdateDate": "11/04/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363AM0700X",
        "TaxonomyName": "Medical Physician Assistant",
        "LicenseNumber": null,
        "LicenseNumberStateCode": "UT",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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