Individual
JORDAN CECIL CHILDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
81 BALL PARK RD, HARLAN, KY 40831-1701
(606) 573-8100
Mailing address
PO BOX 572, BEATTYVILLE, KY 41311-0572
(606) 548-2610
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
05453
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/01/2020
Last updated
04/24/2023
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