Provider Demographics
NPI:1942835079
Name:THOMAS, JORDAN SUMMER (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:SUMMER
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:JORDAN
Other - Middle Name:SUMMER
Other - Last Name:PURCELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1801 DORAN RD S
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2884
Mailing Address - Country:US
Mailing Address - Phone:618-267-9546
Mailing Address - Fax:
Practice Address - Street 1:1099 MEDICAL CENTER CIR
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-1179
Practice Address - Country:US
Practice Address - Phone:270-251-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-09
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.008717363A00000X
KYPA3127363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant