MEDICARE: JORDAN ROBERT COWAN APRN

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	363L00000X	Nurse Practitioner	6179909-3102	UT
2	363LF0000X	Family Nurse Practitioner	6179909-4405	UT

General Provider Information

NPI Number	:	1477322063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN ROBERT COWAN APRN

Provider Business Mailing Address
First Line	:	1777 N CELIA WAY
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-4904
Country	:	US
Telephone Number	:	801-815-8897
Fax Number	:

Provider Business Practice Location Address
First Line	:	1756 W ANTELOPE DR
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-1143
Country	:	US
Telephone Number	:	801-773-4840
Fax Number	:

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

Provider Enumeration Date	:	12/25/2023
Last Update Date	:	05/29/2026

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