Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Willow Jordan Dove, PA

Individual provider Physician Assistant · NPI 1679467963

Willow Jordan Dove, PA is a Physician Assistant in Louisville, Kentucky. Qualified in 2025, 1 year ago. Practices with Southeastern Emergency Physicians LLC, a 786-clinician group and accepts Medicare assignment.

Years since qualifying
1
In the registry since
2025
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

1920 Muncie Ave Apt 7
Louisville, KY 40206-2446
Phone: (740) 501-5648
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1679467963
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedJune 3, 2025
Last updated in NPPESJune 3, 2025
Certification dateJune 3, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Group practice Southeastern Emergency Physicians Llc — 786 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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