Provider Demographics
NPI:1093174278
Name:WALDRON, JORDAN E (PA-C)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:E
Last Name:WALDRON
Suffix:
Gender:F
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 1:101 W LOUIS HENNA BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728-1203
Mailing Address - Country:US
Mailing Address - Phone:512-244-4272
Mailing Address - Fax:512-244-2895
Practice Address - Street 1:4316 JAMES CASEY ST
Practice Address - Street 2:BLDG B STE 201
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-7874
Practice Address - Country:US
Practice Address - Phone:512-442-2727
Practice Address - Fax:512-442-2728
Is Sole Proprietor?:No
Enumeration Date:2016-02-17
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA13068363A00000X
ARPT2016-014363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR212483795Medicaid
AR1093174278OtherNPI
TXPA13068OtherMEDICAL LICENSE
ARPA-661OtherMEDICAL LICENSE