Wilson, Jordan

Wilson, Jordan is an individual health care provider with primary practice located at 2428 W Reynolds Ave , Centralia WA 98531. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Behavioral Neurology & Neuropsychiatry, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is his primary health care specialty. Wilson, Jordan can be contacted via phone (360) 330-9044.

Contact Information

Primary practice address
2428 W Reynolds Ave Centralia WA 98531
Phone: (360) 330-9044
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Behavioral Neurology & Neuropsychiatry 2084B0040X 9110440 Florida
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA60855409 Washington

Profile Details

NPI number 1235651720
LBN Legal business name Wilson, Jordan
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 17th, 2017
Last updated Sep 6th, 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 1235651720 NPPES
Washington MEDICAID 2101119

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