Provider Demographics
NPI:1609410307
Name:CAMPBELL, JORDAN ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:ELIZABETH
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:
Other - Last Name:HITSHEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:888 ST PEPPIN DR
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-7410
Mailing Address - Country:US
Mailing Address - Phone:307-349-9577
Mailing Address - Fax:
Practice Address - Street 1:2440 N 11TH ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8102
Practice Address - Country:US
Practice Address - Phone:970-243-0900
Practice Address - Fax:970-245-4235
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-05
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0006305363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty