Provider Demographics
NPI:1578566311
Name:JORDAN, DANA L (PA)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:L
Last Name:JORDAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 HUNTON RD
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-3015
Mailing Address - Country:US
Mailing Address - Phone:316-305-3379
Mailing Address - Fax:
Practice Address - Street 1:425 HUNTON RD
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-3015
Practice Address - Country:US
Practice Address - Phone:316-305-3379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1500601363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100340580CMedicaid
KS100340580CMedicaid
KSS82384Medicare UPIN