Active NPI
Kelly Jean Jordan, EFDA
- Dental Hygienist
- Salem, OR
National Provider Identifier
1023377819
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 6265
- Practice address
- 2300 Lancaster Dr NE
Salem, OR 97305-1223 - Phone
- (503) 370-4313
- NPI assigned
- May 14, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Assistant | 126800000X | |||
| Dental Hygienist | 124Q00000X | 6265 | OR | Primary |
Addresses
Primary practice location
2300 Lancaster Dr NE
Salem, OR 97305-1223
Mailing address
932 Dearborn Ave N
Keizer, OR 97303-6326
Phone (503) 269-1438
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6265 | OR | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1336953600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1347235200000",
"number": "1023377819",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "932 DEARBORN AVE N",
"city": "KEIZER",
"state": "OR",
"postal_code": "973036326",
"telephone_number": "503-269-1438"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2300 LANCASTER DR NE",
"city": "SALEM",
"state": "OR",
"postal_code": "973051223",
"telephone_number": "503-370-4313"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORDAN",
"first_name": "KELLY",
"middle_name": "JEAN",
"name_prefix": "Mrs.",
"credential": "EFDA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-05-14",
"last_updated": "2012-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "126800000X",
"taxonomy_group": "",
"desc": "Dental Assistant",
"state": null,
"license": null,
"primary": false
},
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "OR",
"license": "6265",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salem, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.