Provider Demographics
NPI:1205638921
Name:JORDAN, MAKAYLA LYNN (BA)
Entity type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:LYNN
Last Name:JORDAN
Suffix:
Gender:
Credentials:BA
Other - Prefix:
Other - First Name:MAKAYLA
Other - Middle Name:LYNN
Other - Last Name:CULLUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:5736 E PEA RIDGE RD APT 309
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-2187
Mailing Address - Country:US
Mailing Address - Phone:681-360-2252
Mailing Address - Fax:
Practice Address - Street 1:3450 US ROUTE 60 E
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1609
Practice Address - Country:US
Practice Address - Phone:304-733-0036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator