Provider Demographics
NPI:1851481337
Name:JORDAN, DREXEL L (APN)
Entity Type:Individual
Prefix:MR
First Name:DREXEL
Middle Name:L
Last Name:JORDAN
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 N SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-1956
Mailing Address - Country:US
Mailing Address - Phone:501-350-3055
Mailing Address - Fax:
Practice Address - Street 1:3000 KAVANAUGH BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-3767
Practice Address - Country:US
Practice Address - Phone:501-350-3055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAO1399363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner