Jordan Marie Fahey, ACSM-CEP

Primary specialty

Clinical Exercise PhysiologistTaxonomy code 224Y00000X

License

1074648 Issued in WA

Practice address

1450 5TH St SE Ste 2500
Puyallup, WA 98372-4692

Phone

(253) 381-9848

NPI assigned

Nov 15, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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": "1700006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700006400000",
    "number": "1154196624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2214 N VILLARD ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984062941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 5TH ST SE STE 2500",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983724692",
            "telephone_number": "253-381-9848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAHEY",
        "first_name": "JORDAN",
        "middle_name": "MARIE",
        "credential": "ACSM-CEP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-11-15",
        "last_updated": "2023-11-15",
        "certification_date": "2023-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Y00000X",
            "taxonomy_group": "",
            "desc": "Clinical Exercise Physiologist",
            "state": "WA",
            "license": "1074648",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Exercise Physiologist in Puyallup, WA
• Providers in Puyallup, WA by specialty
• Clinical Exercise Physiologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2023; 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.