{"npi":"1790885341","type":"NPI-1","status":"active","name":{"display":"Mr. Glen Jordan PA-C","other":[],"first":"GLEN","last":"JORDAN","middle":"S.","credential":"PA-C"},"specialty":{"primary_taxonomy":"363AM0700X","primary_taxonomy_description":"Medical Physician Assistant","slug":"medical-physician-assistant","schema_org_specialty":null,"all":[{"code":"363AM0700X","description":"Medical Physician Assistant","primary":true,"state":"WV","license":"01222"}]},"addresses":[{"purpose":"LOCATION","street_1":"1340 HAL GREER BLVD","city":"HUNTINGTON","state":"WV","postal_code":"257013804","country_code":"US","phone":"3043996727","fax":"3043996726"},{"purpose":"MAILING","street_1":"1340 HAL GREER BLVD","city":"HUNTINGTON","state":"WV","postal_code":"257013804","country_code":"US","phone":"3043996727","fax":"3043996726"}],"license":{"state":"WV","number":"01222"},"identifiers":[{"type_code":"01","label":"Other","value":"P00711764","state":"WV","issuer":"MEDICARE RR"},{"type_code":"05","label":"Medicaid","value":"0080124","state":"OH","issuer":null},{"type_code":"05","label":"Medicaid","value":"7100118540","state":"KY","issuer":null},{"type_code":"05","label":"Medicaid","value":"1790885341","state":"WV","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"I20080930000404","type_code":"14-97","type_desc":"PRACTITIONER - PHYSICIAN ASSISTANT","state":"WV","pac_id":"8325115579"}]},"enumeration_date":"2006-09-24","last_updated":"2021-04-13","_meta":{"source":"NPPES","snapshot_date":"2021-04-13","doc_url":"https://findmynpi.com/api"}}