Healthcare Provider Details

I. General information

NPI: 1487345377
Provider Name (Legal Business Name): JORDAN FERRELL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2023
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 GAINSBOROUGH SQ STE 300
CHESAPEAKE VA
23320-1714
US

IV. Provider business mailing address

PO BOX 61
JARVISBURG NC
27947-0061
US

V. Phone/Fax

Practice location:
  • Phone: 757-547-9286
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024187102
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: