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General NPI Number Information
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NPI Number | 1407704174
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Entity Type | Individual
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Provider Name | JORDAN BUMGARDNER
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Gender | Male
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Dates
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Enumeration Date | 03/18/2026
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Last Update Date | 03/18/2026
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Provider Practice Location Address
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Address Line | 110 S MAIN ST
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City | BOILING SPRINGS
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State | NC
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Zip | 28017-9797
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Country | US
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Telephone | 704-406-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 240 TRYON SCHOOL LOOP RD
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City | BESSEMER CITY
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State | NC
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Zip | 28016-7612
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Country | US
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Telephone |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 345114
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License Number State | NC
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