Provider Demographics
NPI:1659801454
Name:RODDY, JORDYN ALEXA (PA-C)
Entity Type:Individual
Prefix:
First Name:JORDYN
Middle Name:ALEXA
Last Name:RODDY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JORDYN
Other - Middle Name:ALEXA
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:10103 RIDGEGATE PARKWAY
Mailing Address - Street 2:ASPEN BUILDING, SUITE 112
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10103 RIDGEGATE PARKWAY
Practice Address - Street 2:ASPEN BUILDING, SUITE 112
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124
Practice Address - Country:US
Practice Address - Phone:303-662-8250
Practice Address - Fax:303-662-8249
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5012363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical