Provider Demographics
NPI:1477219681
Name:ALLENSWORTH, JORDAN
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:ALLENSWORTH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 S EUCLID AVE CB 8054
Mailing Address - Street 2:DEPT OF ANESTHESIOLOGY
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 BARNES JEWISH HOSPITAL PLAZA
Practice Address - Street 2:DEPT OF ANESTHESIOLOGY
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1305
Practice Address - Country:US
Practice Address - Phone:800-862-9980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4734363A00000X
IL085009277363A00000X
MO2024011273363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant