JORDAN LEE EDWARDS (NPI# 1043852775) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043852775 |
| Entity Type | Individual |
| Full Name | JORDAN LEE EDWARDS |
| Credential | NP-C |
| Practice Address |
105 Creekside Office Dr Wentzville MO 63385-3289 |
| Mailing Address |
315 Vinings Blvd O Fallon MO 63366-7582 |
| Practice Telephone | 6366255200 |
| Mailing Telephone | 8706346883 |
| Enumeration Date | 2019-10-15 |
| Last Update Date | 2019-10-22 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
2019026971 | MO | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346841640 | Jordan Wade Edwards | Pharmacist | 1701 W State Highway 114, Grapevine, TX 76051-8652 | 2020-11-03 |
| 1275166274 | Jordan Alexander Edwards | Respiratory Therapist, Registered | 1500 Sw 10th Ave, Topeka, KS 66604-1301 | 2020-02-18 |
| 1689166365 | Jordan Edwards | Counselor | 2113 W Britton Rd, The Village, OK 73120-1505 | 2018-05-30 |
| 1780195198 | Jordan Wesley Edwards | Psychologist | 5901 Encina Rd Ste A, Goleta, CA 93117-2270 | 2017-10-12 |
| 1801269790 | Jordan Edwards | Social Worker | 2611 Woodlawn Rd, Sterling, IL 61081-4151 | 2015-11-02 |
| 1154613677 | Jordan Edwards | Hospitalist | 7590 Miramar Rd Ste C, San Diego, CA 92126-4232 | 2011-05-03 |
| Street Address |
105 CREEKSIDE OFFICE DR |
| City | WENTZVILLE |
| State | MO |
| Zip Code | 63385-3289 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497954846 | Harminder Grewal | Nurse Practitioner | 105 Creekside Office Dr, Wentzville, MO 63385-3289 | 2007-07-16 |
| 1861959769 | Katherine Ellen Venegoni | Nurse Practitioner | 105 Creekside Office Dr, Wentzville, MO 63385-3289 | 2019-02-27 |
| 1275960254 | Deborah Ann Harrell | Registered Nurse | 105 Creekside Office Dr, Wentzville, MO 63385-3289 | 2013-10-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235730243 | Jeffery William Ellis | Pharmacist | 1571 Wentzville Parkway, Wentzville, MO 63385 | 2020-11-05 |
| 1487266011 | Jason Wade Moore | Peer Specialist | 5 West Pearce Boulevard, Wentzville, MO 63385 | 2020-08-17 |
| 1265906176 | Montrice M Haynes | Counselor | 500 Medical Dr., Central Intake, Wentzville, MO 63385 | 2019-01-14 |
| 1841718459 | Linda Duree | Counselor | 7105 Whisper Creek Dr, Wentzville, MO 63385 | 2017-09-03 |
| 1811349368 | Sara Kleinlein | Social Worker | 500 Medical Drive, Wentzville, MO 63385 | 2016-07-08 |
| 1275980757 | Teona Moeller | Nurse Practitioner | 1598 West Meyer Dr., Wentzville, MO 63385 | 2016-05-16 |
| 1831561273 | Jay F. Hauser, Dds, PC | Dentist | 11 Wentzville Bluffs Drive, Wentzville, MO 63385 | 2015-10-26 |
| 1720402035 | Shara Kuehl | Speech-Language Pathologist | One Campus Drive, Wentzville, MO 63385 | 2014-02-06 |
| 1336480474 | Simply Loyal In Home and Transport Services LLC | Home Health | 152 Enterprise Dr, Wentzille, MO 63385 | 2013-03-14 |
| 1750641338 | Missouri Dental Professionals, Richard Straus, Dmd, PC | Dentist | 1849 Wentzville Parkway, Wentzville, MO 63385 | 2012-05-17 |
| Find all providers in zip 63385 | ||||
| Taxonomy Code | 363LA2200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Adult Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336649276 | Alyssa S Keiner | Nurse Practitioner | 1620 Springmill Dr, Wentzville, MO 63385-3013 | 2018-02-16 |
| 1699168633 | Advance Practice Surgical Assisting LLC | Nurse Practitioner | 1334 Heritage Pkwy, Wentzville, MO 63385-3570 | 2015-03-16 |
| 1780168005 | Premier Surgical Assisting, LLC | Nurse Practitioner | 1334 Heritage Pkwy, Wentzville, MO 63385-3570 | 2018-09-21 |
| 1639531148 | Us Mens Medical Center | Nurse Practitioner | 1334 Heritage Pkwy, Wentzville, MO 63385-3570 | 2016-03-23 |
| 1538554167 | Derek Lambert | Nurse Practitioner | 1334 Heritage Pkwy, Wentzville, MO 63385-3570 | 2015-03-31 |
| 1982714853 | Daniel Shipp | Nurse Practitioner | 1603 Wentzville Pkwy, Wentzville, MO 63385-3438 | 2006-08-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023619285 | Jennifer Lee Speiser | Nurse Practitioner | 12545 Olive Blvd, Saint Louis, MO 63141-6311 | 2020-11-04 |
| 1215537220 | John Franklin Niswonger | Nurse Practitioner | 861 Canyon Trl, Jackson, MO 63755-4001 | 2020-10-28 |
| 1972119014 | Michael Christopher Hassert | Nurse Practitioner | 2290 Graystone Dr, Saint Charles, MO 63303-5159 | 2020-09-22 |
| 1265045264 | Andrea Jane Montgomery | Nurse Practitioner | 444 Honeysuckle Ln, Saint Louis, MO 63119-4521 | 2020-08-28 |
| 1710596424 | Clay Thornburg | Nurse Practitioner | 602 S Home St, Palmyra, MO 63461-1747 | 2020-07-28 |
| 1396362224 | Erin M Kehoe | Nurse Practitioner | 12973 Olive Blvd, Saint Louis, MO 63141-6149 | 2020-06-26 |
| 1508482506 | Matthew Dale Tieskoetter | Nurse Practitioner | 333 S Kirkwood Rd Ste 203, Saint Louis, MO 63122-6161 | 2020-06-25 |
| 1497391924 | Stephnie Michelle Wriedt | Nurse Practitioner | 1605 E Broadway Ste 250, Columbia, MO 65201-8031 | 2019-11-19 |
| 1861033615 | Benedicta Esi | Nurse Practitioner | 6024 Pennsylvania Ave, Saint Louis, MO 63111-2555 | 2019-10-02 |
| 1245896893 | Katina D Smith | Nurse Practitioner | 8820 Mcnulty Dr, Saint Louis, MO 63114-4146 | 2019-05-18 |
| Find all providers with the same taxonomy | ||||
| City | WENTZVILLE |
| Zip Code | 63385 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.