Kathy Q. Jordan, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

1573-C Issued in AR

Legal business name

KATHY Q. JORDAN, LLC

Doing business as

Kathy Q. Jordan, LCSW, LLC

Practice address

1 W Sunbridge Dr
Fayetteville, AR 72703-1825

Phone

(479) 443-5575

Fax

(479) 443-9554

NPI assigned

Sep 15, 2011

Last updated

Sep 15, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kathy Quarles Jordan, LCSWNPI 1881623197

Title

Owner

Phone

(479) 443-5575

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Kathy Q. Jordan, LCSW, LLC Doing business as

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kathy Quarles Jordan, LCSW

  • Clinical Social Worker
  • Fayetteville, AR
  • NPI 1881623197
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1316044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316044800000",
    "number": "1467734400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 W SUNBRIDGE DR",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727031825",
            "telephone_number": "479-443-5575",
            "fax_number": "479-443-9554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 W SUNBRIDGE DR",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727031825",
            "telephone_number": "479-443-5575",
            "fax_number": "479-443-9554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KATHY Q. JORDAN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-15",
        "last_updated": "2011-09-15",
        "status": "A",
        "authorized_official_last_name": "JORDAN",
        "authorized_official_first_name": "KATHY",
        "authorized_official_middle_name": "QUARLES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-443-5575",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "AR",
            "license": "1573-C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1881623197",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kathy Q. Jordan, LCSW, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Nancy S Kay, RN, LPC

• Clinical Social Worker in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Clinical Social Worker in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.