Jordan Payne Hellums, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA2113312TX Issued in TX

Practice address

4138 19TH St
Lubbock, TX 79407-2403

Phone

(806) 780-2329

Fax

(806) 780-2330

NPI assigned

Jul 22, 2015

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

Other names 1

• Jordan Payne Tarver Former name

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": "1437523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477353600000",
    "number": "1265817035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2431 S LOOP 289",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794231519",
            "telephone_number": "806-771-8008",
            "fax_number": "806-771-8009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4138 19TH ST",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794072403",
            "telephone_number": "806-780-2329",
            "fax_number": "806-780-2330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HELLUMS",
        "first_name": "JORDAN",
        "middle_name": "PAYNE",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-07-22",
        "last_updated": "2016-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TX",
            "license": "PTA2113312TX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JORDAN",
            "last_name": "TARVER",
            "middle_name": "PAYNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Bennett Ellen Hargrove Henderson, M.D.

• All providers in Lubbock, TX
• Physical Therapy Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2016; 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.