Jordan Dale Whitaker, PA

NPI #1659922250 in Mount Vernon, Kentucky

Provider Information

NPI Number: 1659922250
Entity Type: Individual
Name: Jordan Dale Whitaker, PA
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Physician Assistant
Credential: PA
Enumeration Date: Sep 25, 2019
Last Updated: Sep 25, 2019

Practice Location

Address: 1770 LAKE CUMBERLAND RD
City: Mount Vernon
State: Kentucky
ZIP Code: 40456-8431
Phone: (606) 256-7488

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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