MEDICARE: JORDAN MACKENZIE HUMBIRD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WX0003X	Inpatient Obstetric Registered Nurse	341258	NC

General Provider Information

NPI Number	:	1245198175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN MACKENZIE HUMBIRD

Provider Business Mailing Address
First Line	:	8933 AVEBURY DR APT J
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28213-3100
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8933 AVEBURY DR APT J
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28213-3100
Country	:	US
Telephone Number	:	980-205-4612
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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