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General NPI Number Information
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NPI Number | 1235865775
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Entity Type | Individual
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Provider Name | TERESA LYNN JORDAN PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/27/2022
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Last Update Date | 08/31/2024
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Provider Practice Location Address
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Address Line | 601 STATE ROUTE 664 N
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City | LOGAN
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State | OH
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Zip | 43138-8541
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Country | US
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Telephone | 740-380-8410
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Fax | 740-380-3314
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Provider Business Mailing Address
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Address Line | 601 STATE ROUTE 664 N
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City | LOGAN
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State | OH
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Zip | 43138-8541
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Country | US
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Telephone | 740-380-8410
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Fax | 740-380-3314
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN.CNP.0031923
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License Number State | OH
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