Provider Demographics
NPI:1992573182
Name:HAMILTON, JORDAN WALKER (SRNA)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:WALKER
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:SRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 WOLFORD AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:KY
Mailing Address - Zip Code:42539-3375
Mailing Address - Country:US
Mailing Address - Phone:606-706-0007
Mailing Address - Fax:
Practice Address - Street 1:591 WOLFORD AVE
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:42539-3375
Practice Address - Country:US
Practice Address - Phone:606-706-0007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care