Healthcare Provider Details

I. General information

NPI: 1164097630
Provider Name (Legal Business Name): JORDANA LEE KANE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 08/13/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 CHERRY ST
MONTGOMERY AL
36107-2613
US

IV. Provider business mailing address

1845 CHERRY ST
MONTGOMERY AL
36107-2613
US

V. Phone/Fax

Practice location:
  • Phone: 334-420-5001
  • Fax:
Mailing address:
  • Phone: 334-420-5001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-185885
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR41381
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: