Provider Demographics
NPI:1013549682
Name:COYKENDALL, JORDAN LEIGH (NP)
Entity Type:Individual
Prefix:MS
First Name:JORDAN
Middle Name:LEIGH
Last Name:COYKENDALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:LEIGH
Other - Last Name:BARBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1669 PITTSFORD VICTOR RD STE 100
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-9666
Mailing Address - Country:US
Mailing Address - Phone:585-276-7500
Mailing Address - Fax:585-218-0520
Practice Address - Street 1:1669 PITTSFORD VICTOR RD STE 100
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-9666
Practice Address - Country:US
Practice Address - Phone:585-276-7500
Practice Address - Fax:585-218-0520
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY697515163WG0000X
NYF345411363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice