Individual
JORDAN LIGHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1 MACKLEM DR, WILMORE, KY 40390-1152
(360) 773-0106
Mailing address
1 MACKLEM DR, WILMORE, KY 40390-1152
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT1174
KY
Other
Enumeration date
05/16/2015
Last updated
05/16/2015
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