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General NPI Number Information
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NPI Number | 1609598499
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Entity Type | Individual
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Provider Name | CASAUNDRA JAE JORDAN CRNP
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Gender | Female
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Dates
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Enumeration Date | 09/19/2022
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 2000 PEPPERELL PKWY
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City | OPELIKA
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State | AL
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Zip | 36801-5452
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Country | US
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Telephone | 334-444-6314
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1645
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City | AUBURN
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State | AL
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Zip | 36831-1645
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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 | 363LN0005X
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Taxonomy Name | Critical Care Neonatal Nurse Practitioner
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License Number | 1-102421
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1-102421
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License Number State | AL
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