Provider Demographics
NPI:1588129423
Name:KINNEY, JORDAN N (PA)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:N
Last Name:KINNEY
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:N
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-2223
Mailing Address - Fax:319-353-6754
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-2223
Practice Address - Fax:319-353-6754
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA094993363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant