Healthcare Provider Details

I. General information

NPI: 1609598499
Provider Name (Legal Business Name): CASAUNDRA JAE JORDAN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. CASEY JAE JORDAN

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 PEPPERELL PKWY
OPELIKA AL
36801-5452
US

IV. Provider business mailing address

PO BOX 1645
AUBURN AL
36831-1645
US

V. Phone/Fax

Practice location:
  • Phone: 334-444-6314
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number1-102421
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-102421
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: