Edelen, Jordan M

Edelen, Jordan M is an individual health care provider with primary practice located at 908 Dupont Rd , Louisville KY 40207-4602. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Edelen, Jordan M can be contacted via phone (502) 749-7909.

Contact Information

Primary practice address
908 Dupont Rd Louisville KY 40207-4602
Phone: (502) 749-7909
Fax: (502) 749-9397
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA2072 Kentucky

Profile Details

NPI number 1851764807
LBN Legal business name Edelen, Jordan M
Credentials PAC
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 12th, 2015
Last updated Mar 20th, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1851764807 NPPES
Kentucky MEDICAID 7100375380

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