Provider Demographics
NPI:1598499972
Name:DEAN, JORDAN (PA)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 N GLADSTONE AVE STE E
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-5380
Mailing Address - Country:US
Mailing Address - Phone:812-287-6157
Mailing Address - Fax:
Practice Address - Street 1:1655 N GLADSTONE AVE STE E
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5380
Practice Address - Country:US
Practice Address - Phone:812-287-6157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant