Active NPI
Kathy Quarles Jordan, LCSW
- Clinical Social Worker
- Fayetteville, AR
National Provider Identifier
1881623197
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 1573-C
- Practice address
- 12 W. Sunbridge
Fayetteville, AR 72703 - Phone
- (479) 750-2020
- Fax
- (479) 750-8967
- NPI assigned
- Jun 30, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 1573-C | AR | Primary |
Addresses
Primary practice location
12 W. Sunbridge
Fayetteville, AR 72703
Mailing address
P.O. Box 6430
Springdale, AR 72766
Phone (479) 750-2020
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5Y996 | Other | AR | BLUE SHIELD PROVIDER # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kathy Q. Jordan, LLC | Clinical | Current | Accepting new patients |
| Ozark Guidance Center, Inc | Past | Accepting new patients | |
| Ozark Guidance Center, Inc | Past | Accepting new patients |
Locations
1 W Sunbridge Dr
Fayetteville, AR 72703
Phone (479) 443-5575
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Social Worker
- Fayetteville, AR
- NPI 1467734400
-
- Community/Behavioral Health Agency
- Springdale, AR
- NPI 1609875186
-
- Family Medicine Physician
- Springdale, AR
- NPI 1659945194
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151625600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1306800000000",
"number": "1881623197",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 6430",
"city": "SPRINGDALE",
"state": "AR",
"postal_code": "72766",
"telephone_number": "479-750-2020",
"fax_number": "479-750-8967"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12 W. SUNBRIDGE",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "72703",
"telephone_number": "479-750-2020",
"fax_number": "479-750-8967"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORDAN",
"first_name": "KATHY",
"middle_name": "QUARLES",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-30",
"last_updated": "2011-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "AR",
"license": "1573-C",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD PROVIDER #",
"identifier": "5Y996",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.