Provider Demographics
NPI:1720887375
Name:HEDKE, JORDAN ELYSE (PA-C)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:ELYSE
Last Name:HEDKE
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 1:118 SHINE DR
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-1513
Mailing Address - Country:US
Mailing Address - Phone:509-572-8462
Mailing Address - Fax:
Practice Address - Street 1:521 MONTGOMERY HWY STE 117
Practice Address - Street 2:
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35216-1876
Practice Address - Country:US
Practice Address - Phone:205-824-4441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2557363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant