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General NPI Number Information
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NPI Number | 1093422842
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Entity Type | Individual
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Provider Name | JORDAN BRODY STEVENS FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/01/2022
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 1381 WESTGATE CENTER DR
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City | WINSTON SALEM
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State | NC
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Zip | 27103-2934
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Country | US
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Telephone | 336-718-0100
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Fax | 336-718-0120
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Provider Business Mailing Address
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Address Line | 8109 HINSON FARM RD STE 504
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City | ALEXANDRIA
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State | VA
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Zip | 22306-3411
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Country | US
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Telephone | 703-780-2800
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0024185686
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5022047
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024185686
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5022047
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License Number State | NC
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