Healthcare Provider Details

I. General information

NPI: 1467218719
Provider Name (Legal Business Name): JORDAN MCKENZIE OSBORNE PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6107 PINEWOOD RD
NUNNELLY TN
37137-2523
US

IV. Provider business mailing address

1065 NE 125TH ST STE 300
NORTH MIAMI FL
33161-5833
US

V. Phone/Fax

Practice location:
  • Phone: 888-852-6672
  • Fax: 305-891-4228
Mailing address:
  • Phone: 888-852-6672
  • Fax: 305-891-4228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number35795
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: