Healthcare Provider Details

I. General information

NPI: 1568706307
Provider Name (Legal Business Name): KESHIA NICHOLE JORDAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2012
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 SIARON WAY
HAMILTON OH
45011-2684
US

IV. Provider business mailing address

3515 SIARON WAY
HAMILTON OH
45011-2684
US

V. Phone/Fax

Practice location:
  • Phone: 513-278-8141
  • Fax:
Mailing address:
  • Phone: 513-278-8141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberAPRN.CNP.14076
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.14076-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: