Healthcare Provider Details

I. General information

NPI: 1376475913
Provider Name (Legal Business Name): JORDAN ELIZABETH HOPPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

109 S CAMPBELL STATION RD
FARRAGUT TN
37934-2845
US

IV. Provider business mailing address

213 COLLEGE ST
BARBOURVILLE KY
40906-1407
US

V. Phone/Fax

Practice location:
  • Phone: 865-622-8898
  • Fax:
Mailing address:
  • Phone: 606-545-8054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13117
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: