JORDAN BURKE (NPI# 1659701696) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659701696 |
| Entity Type | Individual |
| Full Name | JORDAN BURKE |
| Credential | PA |
| Practice Address |
4600 Fort Henry Dr Kingsport TN 37663 |
| Mailing Address |
4600 Fort Henry Dr Kingsport TN 37663-2617 |
| Practice Telephone | 4232243950 |
| Practice Fax Number | 4232243959 |
| Mailing Telephone | 4232243950 |
| Mailing Fax Number | 4232243959 |
| Enumeration Date | 2013-11-12 |
| Last Update Date | 2018-06-04 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | 0110004691 | VA | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363A00000X | Physician Assistant | 2436 | TN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | 1659701696 | 05 | |
| TN | Q003860 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 111 W Stone Dr Ste 110, Kingsport, TN 376606027 | 4232243701 | 4232243709 |
| 378 Marketplace Dr Ste 5, Johnson City, TN 376042361 | 4232820751 | 4232821577 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356981351 | Jordan Rae Burke | Nurse Practitioner | 11943 El Camino Real Ste 100, San Diego, CA 92130-2597 | 2020-01-08 |
| 1942842125 | Jordan Burke | Behavior Technician | 500 Barfield Dr, Hastings, MI 49058-9018 | 2019-10-09 |
| 1871081919 | Jordan Scott Burke | Student in an Organized Health Care Education/Training Program | 1600 Sw Archer Rd, Gainesville, FL 32610-3003 | 2018-04-24 |
| Street Address |
4600 FORT HENRY DR |
| City | KINGSPORT |
| State | TN |
| Zip Code | 37663 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194777953 | Nicholas Brett Smith | Family Medicine | 4600 Fort Henry Dr, Kingsport, TN 37663 | 2006-05-17 |
| 1649518309 | Blue Ridge Medical Managgement Corporation | Clinic/Center | 4600 Fort Henry Dr, Kingsport, TN 37663 | 2013-01-30 |
| 1790001469 | Lindsey R Gray | Nurse Practitioner | 4600 Fort Henry Dr, Kingsport, TN 37663-2617 | 2010-04-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649528126 | Northland Hearing Centers, Inc. | Hearing Instrument Specialist | 1567 North Eastman Road, Kingsport, TN 37663 | 2012-08-15 |
| 1548546419 | Vickie R Harris | Counselor | 317 Pitt Road, Kingsport, TN 37663 | 2011-10-24 |
| 1467746446 | Eric A. Echard | Dentist | 1339 Moreland Drive, Suite 1, Kingsport, TN 37663 | 2011-06-07 |
| 1619003399 | Colonial Heights Pharmacy, Inc. | Pharmacy | 4221 Ft. Henry Drive, Kingsport, TN 37663 | 2007-02-26 |
| 1316005986 | Robert F Mcamis Jr. | Dentist | 4016 Fort Henry Drive, Kingsport, TN 37663 | 2006-12-05 |
| 1467567412 | Colonial Heights Dental Assocaites | Dentist | 150 Clinic Drive, Suite A, Kingsport, TN 37663 | 2006-08-20 |
| 1396720108 | Resp-i-care, Inc. | Durable Medical Equipment & Medical Supplies | 648 Eastern Star Rd, Kingsport, TN 37663 | 2005-12-14 |
| 1023000429 | Darryl Fontaine | Anesthesiology | 4105 Fort Henry Drive, Suite 207, Kingsport, TN 37663 | 2005-08-22 |
| 1982809935 | Sullivan County Regional | Case Manager/Care Coordinator | 154 Blountville Bypass, Blountville, TN 37663 | 2007-06-19 |
| 1265689145 | Danette Nicole Price | Physical Therapist | 208 Mcteer Dr, Kingsport, TN 37663-2011 | 2008-08-22 |
| Find all providers in zip 37663 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073965679 | Teresa Anne Starke | Physician Assistant | 8 Sheridan Square, Suite 110, Kingsport, TN 37660 | 2016-07-07 |
| 1386041101 | Dustin L Barrett | Physician Assistant | 2050 Meadowwview Pkwy., Kingsport, TN 37660-7475 | 2014-11-21 |
| 1265603914 | Stephen Timothy Lawson | Physician Assistant | 121 E Ravine Rd Ste 200, Kingsport, TN 37660-3826 | 2008-03-20 |
| 1477751238 | Clay Deneeen Davis | Physician Assistant | 4509 W Stone Dr, Kingsport, TN 37660-1048 | 2007-07-03 |
| 1932310828 | Cumberland Back Pain Clinic | Physician Assistant | 1732 N Eastman Rd, Kingsport, TN 37664-2376 | 2007-05-24 |
| 1568567535 | William Kendall Johnson | Physician Assistant | 3 Sheridan Square, Kingsport, TN 37660 | 2006-09-14 |
| 1306941372 | Clark Rafael Hernandez | Physician Assistant | Three Sheridan Square, Kingsport, TN 37660 | 2006-09-14 |
| 1598364903 | Kevin White | Physician Assistant | 130 W Ravine Rd, Kingsport, TN 37660-3837 | 2020-10-19 |
| 1770195273 | Daulton Horne | Physician Assistant | 105 W Stone Dr Ste 4b, Kingsport, TN 37660-3365 | 2020-08-18 |
| 1245855501 | Carley Neil Carter | Physician Assistant | 105 W Stone Dr Ste 4b, Kingsport, TN 37660-3365 | 2020-06-12 |
| Find all providers in KINGSPORT | ||||
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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.