Healthcare Provider Details

I. General information

NPI: 1689514184
Provider Name (Legal Business Name): DAKOTA PAIGE JORDAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NEW WAVERLY PL STE 201
CARY NC
27518-7404
US

IV. Provider business mailing address

1320 UMSTEAD HOLLOW PL APT 1320
CARY NC
27513-8462
US

V. Phone/Fax

Practice location:
  • Phone: 919-594-1649
  • Fax: 919-917-7148
Mailing address:
  • Phone: 919-594-1649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: