Provider Demographics
NPI:1770458143
Name:JORDAN, RICHARD ALLEN JR
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ALLEN
Last Name:JORDAN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2779 GUYAN AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25702-1141
Mailing Address - Country:US
Mailing Address - Phone:304-952-4078
Mailing Address - Fax:
Practice Address - Street 1:1707 RT 60W
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WV
Practice Address - Zip Code:25541
Practice Address - Country:US
Practice Address - Phone:304-743-6180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-07
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant