Provider Demographics
NPI:1609368380
Name:IVEY, JORDAN KEELEY (MD)
Entity Type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:KEELEY
Last Name:IVEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:MICHELLE
Other - Last Name:KEELEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1212 HUNTSVILLE HILLS DR SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-2722
Mailing Address - Country:US
Mailing Address - Phone:334-714-4587
Mailing Address - Fax:
Practice Address - Street 1:104 J E BRISCOE WAY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-4822
Practice Address - Country:US
Practice Address - Phone:256-705-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AL44203207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program