Healthcare Provider Details

I. General information

NPI: 1336725050
Provider Name (Legal Business Name): ROBERT JAMES JORDAN FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 HEALTH CENTER DR
AHOSKIE NC
27910-8161
US

IV. Provider business mailing address

PO BOX 669
AHOSKIE NC
27910-0669
US

V. Phone/Fax

Practice location:
  • Phone: 252-332-3548
  • Fax: 252-332-1665
Mailing address:
  • Phone: 252-209-0237
  • Fax: 252-209-0197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5014223
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5014223
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: