Provider Demographics
NPI:1689197469
Name:BEALL, JORDAN SIMONE (PA-C)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:SIMONE
Last Name:BEALL
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:43 WHITING HILL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1006
Mailing Address - Country:US
Mailing Address - Phone:207-973-5035
Mailing Address - Fax:207-973-5042
Practice Address - Street 1:895 UNION ST STE 12
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3054
Practice Address - Country:US
Practice Address - Phone:207-973-7979
Practice Address - Fax:207-947-9579
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
MEPA1733363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant