Jordan Anderson

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

14624 Issued in MN

Practice address

15655 37TH Ave N Ste 100
Plymouth, MN 55446-4003

Phone

(612) 293-7822

Fax

(630) 509-4420

NPI assigned

Sep 23, 2021

Last updated

Oct 6, 2023By the provider in NPPES

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

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": "1632355200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696550400000",
    "number": "1972274660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 1ST ST SW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559050001",
            "telephone_number": "507-284-2511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15655 37TH AVE N STE 100",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554464003",
            "telephone_number": "612-293-7822",
            "fax_number": "630-509-4420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "JORDAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-23",
        "last_updated": "2023-10-06",
        "certification_date": "2023-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MN",
            "license": "14624",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joel Dean Amundson, RPH
• Wendy Andersen, LMT
• Alahna Anderson
• Alan E Anderson, O.D.
• Erik Weston Anderson, MD
• Kyle John Anderson, MD
• Rebecca Anderson, M.D.
• Sandra Mae Anderson, LPCC
• Shauna Anderson, D.D.S.
• Shelly L Anderson, M.D.

• Medical Physician Assistant in Plymouth, MN
• Providers in Plymouth, MN by specialty
• Medical Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2023; 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.