Healthcare Provider Details

I. General information

NPI: 1447782354
Provider Name (Legal Business Name): JORDAN GIBBLE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JORDAN FAYEN

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 N 4TH ST
WILMINGTON NC
28401-3450
US

IV. Provider business mailing address

113 S PINE ST
WARSAW NC
28398-1924
US

V. Phone/Fax

Practice location:
  • Phone: 910-343-0270
  • Fax:
Mailing address:
  • Phone: 910-293-7246
  • Fax: 910-267-8988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number292012
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: