Healthcare Provider Details

I. General information

NPI: 1245920073
Provider Name (Legal Business Name): JORDAN GILDEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MEMORIAL DR
GREER SC
29650-1518
US

IV. Provider business mailing address

3807 WHITE HORSE RD STE D&E
GREENVILLE SC
29611-5598
US

V. Phone/Fax

Practice location:
  • Phone: 864-848-7005
  • Fax:
Mailing address:
  • Phone: 864-881-2252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number27223
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: