Provider Demographics
NPI:1346754090
Name:WILLIAMS, JORDAN MICHAEL (PA-C)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:MICHAEL
Last Name:WILLIAMS
Suffix:
Gender:
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 1:4110 22ND PL
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1122
Mailing Address - Country:US
Mailing Address - Phone:806-792-4329
Mailing Address - Fax:
Practice Address - Street 1:4110 22ND PL
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1122
Practice Address - Country:US
Practice Address - Phone:806-792-4329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-16
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA18970363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical