Healthcare Provider Details

I. General information

NPI: 1194472571
Provider Name (Legal Business Name): ALEXANDRA DEVALL JORDAN MSN, APRN, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2022
Last Update Date: 03/07/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 RUE DE LA VIE ST STE 310
BATON ROUGE LA
70817-5128
US

IV. Provider business mailing address

500 RUE DE LA VIE ST STE 310
BATON ROUGE LA
70817-5128
US

V. Phone/Fax

Practice location:
  • Phone: 225-201-0505
  • Fax:
Mailing address:
  • Phone: 225-201-0505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number224343
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: