Basic Information
| Provider Information | |||||||||
| NPI: | 1720742703 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PARKHURST | ||||||||
| FirstName: | JORDAN | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5806 E GRANDVIEW RD | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852549218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6028820220 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9165 W THUNDERBIRD RD | ||||||||
| Address2: | |||||||||
| City: | PEORIA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853814847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6238763870 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2021 | ||||||||
| LastUpdateDate: | 10/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 8737 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.