Healthcare Provider Details

I. General information

NPI: 1407624919
Provider Name (Legal Business Name): EMILY ROSE JORDAN MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2023
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 BARRETT DR STE 200
RALEIGH NC
27609-7172
US

IV. Provider business mailing address

3700 BARRETT DR STE 200
RALEIGH NC
27609-7172
US

V. Phone/Fax

Practice location:
  • Phone: 919-231-3966
  • Fax: 919-231-3912
Mailing address:
  • Phone: 919-231-3966
  • Fax: 919-231-3912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5024874
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: