Healthcare Provider Details

I. General information

NPI: 1144743501
Provider Name (Legal Business Name): ERIC AUSTIN JORDAN NASH NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4804 W CLEARWATER AVE
KENNEWICK WA
99336-2119
US

IV. Provider business mailing address

550 GAGE BLVD STE 101
RICHLAND WA
99352-9532
US

V. Phone/Fax

Practice location:
  • Phone: 509-942-2355
  • Fax: 509-222-1289
Mailing address:
  • Phone: 509-942-3627
  • Fax: 509-627-2983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60777551
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: