Healthcare Provider Details

I. General information

NPI: 1952227589
Provider Name (Legal Business Name): JORDAN RIVERS MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 UNIVERSITY DR
FAIRFAX VA
22030-4422
US

IV. Provider business mailing address

4400 UNIVERSITY DR
FAIRFAX VA
22030-4422
US

V. Phone/Fax

Practice location:
  • Phone: 703-993-1901
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024197907
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: