Basic Information
| Provider Information | |||||||||
| NPI: | 1053049049 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLORES | ||||||||
| FirstName: | JORDYN | ||||||||
| MiddleName: | MYCHELLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 107 E 23RD ST | ||||||||
| Address2: | |||||||||
| City: | HAYS | ||||||||
| State: | KS | ||||||||
| PostalCode: | 676012814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6204366010 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2220 CANTERBURY DR | ||||||||
| Address2: | |||||||||
| City: | HAYS | ||||||||
| State: | KS | ||||||||
| PostalCode: | 676012370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7856235000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2022 | ||||||||
| LastUpdateDate: | 08/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 149388 | KS | Y | Nursing Service Providers | Registered Nurse |
No ID Information.