Provider Demographics
NPI:1104938398
Name:JORDAN-KEITH, KIER (MN, ARNP)
Entity type:Individual
Prefix:MS
First Name:KIER
Middle Name:
Last Name:JORDAN-KEITH
Suffix:
Gender:F
Credentials:MN, ARNP
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:KIER
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, MN
Mailing Address - Street 1:1120 112TH AVE NE, SUITE 150
Mailing Address - Street 2:OVERLAKE HOSPITAL MEDICAL CENTER-ANTICOAGULATION CLINIC
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004
Mailing Address - Country:US
Mailing Address - Phone:425-688-5846
Mailing Address - Fax:425-688-5281
Practice Address - Street 1:1120 112TH AVE NE, SUITE 150
Practice Address - Street 2:OVERLAKE HOSPITAL MEDICAL CENTER-ANTICOAGULATION CLINIC
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004
Practice Address - Country:US
Practice Address - Phone:425-688-5846
Practice Address - Fax:425-688-5281
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP3000-5814363L00000X
WAAP30005814363L00000X
WARN00106792163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse