Healthcare Provider Details

I. General information

NPI: 1023685716
Provider Name (Legal Business Name): JORDAN LAYNE ESPERSEN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JORDAN ESPERSEN

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 FORTUNES RIDGE DR STE P
DURHAM NC
27713-6102
US

IV. Provider business mailing address

381 COURTLAND AVE
HARLEYSVILLE PA
19438-1673
US

V. Phone/Fax

Practice location:
  • Phone: 919-391-7202
  • Fax: 919-391-7203
Mailing address:
  • Phone: 256-698-4788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2020040466
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5014893
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: