Healthcare Provider Details

I. General information

NPI: 1740140565
Provider Name (Legal Business Name): JORDAN ALYSSA GRAHAM FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2025
Last Update Date: 03/29/2026
Certification Date: 03/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4861 BECHELLI LN STE 500
REDDING CA
96002-3559
US

IV. Provider business mailing address

14595 CHLOE LN
RED BLUFF CA
96080-9844
US

V. Phone/Fax

Practice location:
  • Phone: 530-526-6351
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95038384
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: