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NPI Code Detail

MEDICARE: JORDAN LEIGH UTSEY

MEDICARE: JORDAN LEIGH UTSEY
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
1183700000XPharmacy Technician241498TX

General Provider Information

NPI Number : 1457931909
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN LEIGH UTSEY
Provider Business Mailing Address
First Line : 646 S FLORES ST
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78204-1219
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2990 E BUSINESS 190
Second Line :
City : COPPERAS COVE
State : TX
Zip : 76522-2515
Country : US
Telephone Number : 254-547-9755
Fax Number : 254-547-9858
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2021
Last Update Date : 04/09/2021

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Directions to “ JORDAN LEIGH UTSEY ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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