Healthcare Provider Details

I. General information

NPI: 1568205508
Provider Name (Legal Business Name): KENYA JORDEN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 10/25/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 RIVER OAKS RD W
NEW ORLEANS LA
70123-2162
US

IV. Provider business mailing address

5530 HOLLEY LN
NEW ORLEANS LA
70126-3314
US

V. Phone/Fax

Practice location:
  • Phone: 504-284-0550
  • Fax:
Mailing address:
  • Phone: 504-284-0550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number237785
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberLA158517
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: