Provider Demographics
NPI:1457315947
Name:JORDAN, KIMBERLY ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ELIZABETH
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3975 ROBINSON RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NC
Mailing Address - Zip Code:28658-9715
Mailing Address - Country:US
Mailing Address - Phone:828-466-0466
Mailing Address - Fax:828-466-8862
Practice Address - Street 1:3975 ROBINSON RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NC
Practice Address - Zip Code:28658-9715
Practice Address - Country:US
Practice Address - Phone:828-466-0466
Practice Address - Fax:828-466-8862
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2010-01703207Q00000X
OH35-08-3111-J207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2522569Medicaid
NC2010-01703OtherNC MEDICAL LICENSE
OH4147044Medicare PIN
OHI21404Medicare UPIN
OH2522569Medicaid
OH4147045Medicare PIN
OH4147041Medicare PIN