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General NPI Number Information
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NPI Number | 1417348905
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Entity Type | Individual
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Provider Name | JEREMY DUGGER JORDAN CRNP, CPNP-AC
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Gender | Male
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Dates
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Enumeration Date | 02/05/2015
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Last Update Date | 12/11/2017
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Provider Practice Location Address
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Address Line | 1600 7TH AVE S CPPI 102
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City | BIRMINGHAM
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State | AL
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Zip | 35233-1711
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Country | US
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Telephone | 205-638-3400
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Fax |
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Provider Business Mailing Address
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Address Line | 1720 2ND AVE S # NB308
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City | BIRMINGHAM
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State | AL
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Zip | 35294-1210
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Country | US
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Telephone | 205-996-3651
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Fax | 205-996-7177
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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 | 1-136533
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 1-136533
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 363LP0222X
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Taxonomy Name | Critical Care Pediatric Nurse Practitioner
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License Number | 1-135633
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License Number State | AL
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