Healthcare Provider Details

I. General information

NPI: 1962321109
Provider Name (Legal Business Name): JORDAN KING HUNDERUP FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176C W UNIVERSITY PKWY # C
JACKSON TN
38305-1616
US

IV. Provider business mailing address

743 ALECIA PAGE CV
HUMBOLDT TN
38343-3632
US

V. Phone/Fax

Practice location:
  • Phone: 731-660-6915
  • Fax:
Mailing address:
  • Phone: 731-414-1634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number42313
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: