Healthcare Provider Details

I. General information

NPI: 1982893137
Provider Name (Legal Business Name): SANDRA KAY JORDAN R.D., LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PEARMAN DAIRY RD
ANDERSON SC
29625-3100
US

IV. Provider business mailing address

303 W NORTH AVE
ANDERSON SC
29625-2945
US

V. Phone/Fax

Practice location:
  • Phone: 864-260-5030
  • Fax: 864-260-5074
Mailing address:
  • Phone: 864-224-4280
  • Fax: 864-260-5074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberLD002421
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberR518238
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: