Provider Demographics
NPI:1144306549
Name:TAYLOR, JORDAN E (PNP)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:E
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:E
Other - Last Name:MALLOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1387
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-1387
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1090 W PARK PL
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2785
Practice Address - Country:US
Practice Address - Phone:208-215-2005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP729A363LP0200X
WAAP60904961363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010153955OtherREGENCE BLUE SHIELD
WA1047507Medicaid
MT1144306549Medicaid
AKNP708IDMedicaid
ID807343600Medicaid
WA9653353Medicaid
WAAP60904961OtherARNP
IDNPXN3OtherBLUE CROSS
ID000010153954OtherREGENCE BLUE SHIELD
IDNPXN2OtherBLUE CROSS OF IDAHO