=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548733249
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN SCOTT JORDAN APRN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2019
-----------------------------------------------------
Last Update Date | 10/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 24TH AVE NW
-----------------------------------------------------
City | NORMAN
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73069-6232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-364-0555
-----------------------------------------------------
Fax | 405-573-5464
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3001 QUAIL SPRINGS PKWY FL 5
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73134-2640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-364-0555
-----------------------------------------------------
Fax | 405-573-5464
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 112708
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------