Caren B Jordan, PH.D.
Individual provider Active NPI Psychologist · La Fayette, KY
NPI 1760508402 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1760508402
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 2945 (NC)
- Practice address
- 204 S. Main St.
La Fayette, KY 42254-0014 - Phone
- (270) 271-8287
- NPI assigned
- Mar 22, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2945 | NC | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 2945 | NC | Yes |
Addresses
Primary practice location
204 S. Main St.
La Fayette, KY 42254-0014
Mailing address
PO Box 14
La Fayette, KY 42254-0014
Phone (270) 271-8287
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.