Healthcare Provider Details

I. General information

NPI: 1346057692
Provider Name (Legal Business Name): MRS. JORDAN NICOLE HARMON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 E HOSPITAL DR
ANGLETON TX
77515-4112
US

IV. Provider business mailing address

3714 PARKSHIRE DR
PEARLAND TX
77584-9453
US

V. Phone/Fax

Practice location:
  • Phone: 979-849-7721
  • Fax:
Mailing address:
  • Phone: 409-779-7247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1168886
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: