Healthcare Provider Details

I. General information

NPI: 1669259768
Provider Name (Legal Business Name): JORDAN CUMMINGS CNM, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 INWOOD RD FL 6
DALLAS TX
75235-7202
US

IV. Provider business mailing address

9530 MILLTRAIL DR
DALLAS TX
75238-1422
US

V. Phone/Fax

Practice location:
  • Phone: 214-645-8300
  • Fax:
Mailing address:
  • Phone: 214-562-4477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number1135799
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: