Provider Demographics
NPI:1952014243
Name:FORD, JORDAN TAYLOR (PA)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:TAYLOR
Last Name:FORD
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:
Other - Last Name:KALOUSEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 S TIMBERLANE DR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-6990
Mailing Address - Country:US
Mailing Address - Phone:870-862-2400
Mailing Address - Fax:
Practice Address - Street 1:600 S TIMBERLANE DR
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-6990
Practice Address - Country:US
Practice Address - Phone:870-862-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-02
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant