Provider Demographics
NPI:1407434939
Name:JORDAN, KATELYN L
Entity Type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:L
Last Name:JORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KATELYN
Other - Middle Name:L
Other - Last Name:ARNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11102 LINDBERGH BUSINESS CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-7810
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11102 LINDBERGH BUSINESS CT
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-7810
Practice Address - Country:US
Practice Address - Phone:314-206-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker