MEDICARE: JORDAN ELYSE HEDKE PA-C

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	363A00000X	Physician Assistant	2557	AL

General Provider Information

NPI Number	:	1720887375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN ELYSE HEDKE PA-C

Provider Business Mailing Address
First Line	:	118 SHINE DR
Second Line	:
City	:	PELHAM
State	:	AL
Zip	:	35124-1513
Country	:	US
Telephone Number	:	509-572-8462
Fax Number	:

Provider Business Practice Location Address
First Line	:	521 MONTGOMERY HWY STE 117
Second Line	:
City	:	VESTAVIA HILLS
State	:	AL
Zip	:	35216-1876
Country	:	US
Telephone Number	:	205-824-4441
Fax Number	:

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

Provider Enumeration Date	:	03/07/2025
Last Update Date	:	03/10/2026

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