Jordan Matthew Anderson, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

158897 Issued in OH

Practice address

348 Tanbark Dr
Liberty TWP, OH 45011-2660

Phone

(513) 410-4479

NPI assigned

Jul 23, 2022

Last updated

Jul 23, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1658534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658534400000",
    "number": "1063147932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "348 TANBARK DR",
            "city": "LIBERTY TWP",
            "state": "OH",
            "postal_code": "450112660",
            "telephone_number": "513-410-4479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "348 TANBARK DR",
            "city": "LIBERTY TWP",
            "state": "OH",
            "postal_code": "450112660",
            "telephone_number": "513-410-4479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "JORDAN",
        "middle_name": "MATTHEW",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-07-23",
        "last_updated": "2022-07-23",
        "certification_date": "2022-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OH",
            "license": "158897",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "ReliaCare",
            "affiliation": "N",
            "endpointDescription": "Healthcare services",
            "address_1": "348 Tanbark Dr",
            "city": "Liberty Twp",
            "state": "OH",
            "country_code": "US",
            "postal_code": "450112660",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Licensed Practical Nurse in Liberty TWP, OH
• Providers in Liberty TWP, OH by specialty
• Licensed Practical Nurse in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.