Provider Demographics
NPI:1255824686
Name:KOONTZ, JORDAN LOUISE (PA-C)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:LOUISE
Last Name:KOONTZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 DUNKARD HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:ALUM BANK
Mailing Address - State:PA
Mailing Address - Zip Code:15521-7706
Mailing Address - Country:US
Mailing Address - Phone:814-979-8146
Mailing Address - Fax:
Practice Address - Street 1:214 COLLEGE PARK PLZ
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-2833
Practice Address - Country:US
Practice Address - Phone:888-918-5465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant