MEDICARE: JORDAN NICHOLE LITTLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1447012265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN NICHOLE LITTLE

Provider Business Mailing Address
First Line	:	1 AVENUE C
Second Line	:
City	:	MADISON
State	:	WV
Zip	:	25130-1100
Country	:	US
Telephone Number	:	304-242-8404
Fax Number	:

Provider Business Practice Location Address
First Line	:	1426 LAUREL FRK
Second Line	:
City	:	ALKOL
State	:	WV
Zip	:	25501-9778
Country	:	US
Telephone Number	:	304-955-9524
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2024
Last Update Date	:	01/26/2024

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