Jordan Elizabeth Kudla, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

50.004714RX Issued in OH

Practice address

11100 Euclid Ave
Cleveland, OH 44106-1716

Phone

(216) 844-1000

NPI assigned

Jun 13, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jordan Mungovan Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1465776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571702400000",
    "number": "1720437551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 W 10TH ST",
            "address_2": "APT 602",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441131291",
            "telephone_number": "260-415-9955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11100 EUCLID AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441061716",
            "telephone_number": "216-844-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUDLA",
        "first_name": "JORDAN",
        "middle_name": "ELIZABETH",
        "name_prefix": "Ms.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-13",
        "last_updated": "2019-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.004714RX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JORDAN",
            "last_name": "MUNGOVAN",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Pamela Sue Kucklick, LPCC-S-SUPV
• Marcia A Kucler, CNS
• Mark J Kuczmarski, CRNA
• Abhijith Kudaravalli, DO
• Margaret Kuder
• Matthew Kudla
• Laura Margaret Kudley, CNP
• Gina Josette Kuehn, MD
• Angela Kuemmel, PH.D.
• David M Kuentz, DO, MBA

• Physician Assistant in Cleveland, OH
• Providers in Cleveland, OH by specialty
• Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2019; 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.