Healthcare Provider Details

I. General information

NPI: 1144650623
Provider Name (Legal Business Name): BRANDI JORDAN MS, RD, LDN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRANDI PIGG MS, RD, LDN

II. Dates (important events)

Enumeration Date: 11/19/2013
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12620 CREEKSIDE LAKE CV
ARLINGTON TN
38002-1521
US

IV. Provider business mailing address

12620 CREEKSIDE LAKE CV
ARLINGTON TN
38002-1521
US

V. Phone/Fax

Practice location:
  • Phone: 573-429-8902
  • Fax:
Mailing address:
  • Phone: 573-429-8902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number2588
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-96583
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: