Healthcare Provider Details

I. General information

NPI: 1225622384
Provider Name (Legal Business Name): KRISTIN DANIELLE JORDAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 AIRPORT BLVD
MOBILE AL
36608-3709
US

IV. Provider business mailing address

34820 BRANDON LAKE RD
BAY MINETTE AL
36507-8069
US

V. Phone/Fax

Practice location:
  • Phone: 251-751-8668
  • Fax:
Mailing address:
  • Phone: 251-751-8668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number1-130607
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN11012090
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1-130607
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: