Provider Demographics
NPI:1053024034
Name:AMBER JORDAN
Entity type:Organization
Organization Name:AMBER JORDAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERVENTIONIST
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-595-1500
Mailing Address - Street 1:PO BOX 2602
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40702-2602
Mailing Address - Country:US
Mailing Address - Phone:606-595-1500
Mailing Address - Fax:
Practice Address - Street 1:10128 S US HIGHWAY 25
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-4984
Practice Address - Country:US
Practice Address - Phone:606-595-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency