Provider Demographics
NPI:1275240962
Name:JORDAN, DAVA LYNN (NP)
Entity Type:Individual
Prefix:MRS
First Name:DAVA
Middle Name:LYNN
Last Name:JORDAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 LEADINGHAM LOOP
Mailing Address - Street 2:
Mailing Address - City:OLIVE HILL
Mailing Address - State:KY
Mailing Address - Zip Code:41164-8165
Mailing Address - Country:US
Mailing Address - Phone:606-315-2271
Mailing Address - Fax:
Practice Address - Street 1:316 W 2ND ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1550
Practice Address - Country:US
Practice Address - Phone:606-784-3771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013494363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily