Individual
JORDAN DALE WHITAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1770 LAKE CUMBERLAND RD, MOUNT VERNON, KY 40456-8431
(606) 256-7488
(606) 256-8036
Mailing address
1770 LAKE CUMBERLAND RD, MOUNT VERNON, KY 40456-8431
(606) 256-7488
(606) 256-8036
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
TC870
KY
Other
Enumeration date
09/25/2019
Last updated
09/25/2019
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