Provider Demographics
NPI:1902318595
Name:JORDAN, KARA L (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KARA
Middle Name:L
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 HERBERT ST
Mailing Address - Street 2:
Mailing Address - City:RICHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:43344-1227
Mailing Address - Country:US
Mailing Address - Phone:937-303-3842
Mailing Address - Fax:
Practice Address - Street 1:23 HERBERT ST
Practice Address - Street 2:
Practice Address - City:RICHWOOD
Practice Address - State:OH
Practice Address - Zip Code:43344-1227
Practice Address - Country:US
Practice Address - Phone:937-303-3842
Practice Address - Fax:937-303-3842
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.165419.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse