Provider Demographics
NPI:1073970083
Name:MCFADDEN, JORJA E (PA-C)
Entity Type:Individual
Prefix:
First Name:JORJA
Middle Name:E
Last Name:MCFADDEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JORJA
Other - Middle Name:E
Other - Last Name:MAGLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:200 EAST CHESTNUT BLDG.
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1831
Mailing Address - Country:US
Mailing Address - Phone:502-629-5552
Mailing Address - Fax:
Practice Address - Street 1:200 E CHESTNUT ST BLDG SUITE303
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1831
Practice Address - Country:US
Practice Address - Phone:502-629-5552
Practice Address - Fax:502-629-3132
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA2078363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100401460Medicaid
KYK179150Medicare PIN