Provider Demographics
NPI:1396110169
Name:HALE, JORDAN NEIL (PA-C)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:NEIL
Last Name:HALE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1547 MIDWAY DR STE B
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-6912
Mailing Address - Country:US
Mailing Address - Phone:208-497-0429
Mailing Address - Fax:208-497-0430
Practice Address - Street 1:1547 MIDWAY DR STE B
Practice Address - Street 2:
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-6912
Practice Address - Country:US
Practice Address - Phone:208-497-0429
Practice Address - Fax:208-497-0430
Is Sole Proprietor?:No
Enumeration Date:2015-12-04
Last Update Date:2020-05-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA53080363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant