Provider Demographics
NPI:1306077433
Name:JORDAN, RICKEY LYNN (RN)
Entity type:Individual
Prefix:
First Name:RICKEY
Middle Name:LYNN
Last Name:JORDAN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4820 POWDERHORN DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45244-1253
Mailing Address - Country:US
Mailing Address - Phone:513-289-8302
Mailing Address - Fax:513-528-3352
Practice Address - Street 1:4820 POWDERHORN DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45244-1253
Practice Address - Country:US
Practice Address - Phone:513-289-8302
Practice Address - Fax:513-528-3352
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN310764163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse