Provider Demographics
NPI:1952707895
Name:BULCHER, JORDAN NICHOLAS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:NICHOLAS
Last Name:BULCHER
Suffix:
Gender:M
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 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-870-3669
Mailing Address - Fax:614-870-3449
Practice Address - Street 1:7811 FLINT RD STE C
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-6420
Practice Address - Country:US
Practice Address - Phone:614-870-3669
Practice Address - Fax:614-870-3449
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.004092363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0119385Medicaid
OH0119385Medicaid