Provider Demographics
NPI:1285230177
Name:KOEHLER, JORDYN HUDGINS (PA-C)
Entity type:Individual
Prefix:
First Name:JORDYN
Middle Name:HUDGINS
Last Name:KOEHLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6016 KIRKWYND COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-6660
Mailing Address - Country:US
Mailing Address - Phone:704-806-0636
Mailing Address - Fax:
Practice Address - Street 1:5950 FAIRVIEW RD STE 808
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-2110
Practice Address - Country:US
Practice Address - Phone:910-323-1545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001010814363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant