Provider Demographics
NPI:1447012265
Name:LITTLE, JORDAN NICHOLE
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:NICHOLE
Last Name:LITTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WV
Mailing Address - Zip Code:25130-1100
Mailing Address - Country:US
Mailing Address - Phone:304-242-8404
Mailing Address - Fax:
Practice Address - Street 1:1426 LAUREL FRK
Practice Address - Street 2:
Practice Address - City:ALKOL
Practice Address - State:WV
Practice Address - Zip Code:25501-9778
Practice Address - Country:US
Practice Address - Phone:304-955-9524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant