Healthcare Provider Details

I. General information

NPI: 1619832003
Provider Name (Legal Business Name): EMILY DEMING JORDAN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 NAVAHO DR STE 204
RALEIGH NC
27609-7366
US

IV. Provider business mailing address

4509 TETBURY PL
RALEIGH NC
27613-4058
US

V. Phone/Fax

Practice location:
  • Phone: 919-917-7273
  • Fax: 984-333-9160
Mailing address:
  • Phone: 919-607-9699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5023655
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: