Healthcare Provider Details

I. General information

NPI: 1720125891
Provider Name (Legal Business Name): KAREN ELIZABETH JORDAN ANP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 12/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 SOUTH NATIONAL AVENUE
SPRINGFIELD MO
65807
US

IV. Provider business mailing address

PO BOX 9007
SPRINGFIELD MO
65808-9007
US

V. Phone/Fax

Practice location:
  • Phone: 417-875-2520
  • Fax:
Mailing address:
  • Phone: 417-875-3462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2017006975
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: