Provider Demographics
NPI:1265842637
Name:JORDAN, KATHERINE (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNC DEPT OF PEDIATRICS
Mailing Address - Street 2:260 MACNIDER BUILDING, CB# 7220
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7220
Mailing Address - Country:US
Mailing Address - Phone:919-966-1505
Mailing Address - Fax:919-966-7299
Practice Address - Street 1:6715 MCCRIMMON PKWY STE 300
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-1916
Practice Address - Country:US
Practice Address - Phone:919-481-4997
Practice Address - Fax:919-388-3271
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-06
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201369390200000X
NC2017-00416208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program