Basic Information
| Provider Information | |||||||||
| NPI: | 1265842637 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JORDAN | ||||||||
| FirstName: | KATHERINE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | UNC DEPT OF PEDIATRICS | ||||||||
| Address2: | 260 MACNIDER BUILDING, CB# 7220 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275997220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199661505 | ||||||||
| FaxNumber: | 9199667299 | ||||||||
| Practice Location | |||||||||
| Address1: | 6715 MCCRIMMON PKWY STE 300 | ||||||||
| Address2: | |||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275191916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194814997 | ||||||||
| FaxNumber: | 9193883271 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2014 | ||||||||
| LastUpdateDate: | 05/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 201369 | NC | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208000000X | 2017-00416 | NC | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.