Provider Demographics
NPI:1376921536
Name:JORDAN, KIM H
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:H
Last Name:JORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 CANTERBURY LN
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-2711
Mailing Address - Country:US
Mailing Address - Phone:804-855-9503
Mailing Address - Fax:
Practice Address - Street 1:1305 CANTERBURY LN
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2711
Practice Address - Country:US
Practice Address - Phone:804-855-9503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-08
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)