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NPI Code Detail

MEDICARE: JUDY ANN JORDAN RN

MEDICARE: JUDY ANN JORDAN RN
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
1163W00000XRegistered Nurse2010024055MO
2163WP0809XAdult Psychiatric/Mental Health Registered Nurse14-130459-062KS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1639564313
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUDY ANN JORDAN RN
Provider Business Mailing Address
First Line : 2205 W 36TH AVE
Second Line :
City : KANSAS CITY
State : KS
Zip : 66103-2107
Country : US
Telephone Number : 913-956-5620
Fax Number :
Provider Business Practice Location Address
First Line : 7321 NW 79TH ST
Second Line :
City : KANSAS CITY
State : MO
Zip : 64152-2150
Country : US
Telephone Number : 816-853-9354
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2015
Last Update Date : 03/31/2015

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