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General NPI Number Information
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NPI Number | 1629518626
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Entity Type | Individual
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Provider Name | MARY ELISABETH JORDAN FNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/24/2017
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 4665 MAIN ST SUITE 2
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City | JASPER
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State | TN
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Zip | 37347
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Country | US
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Telephone | 423-942-0145
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Fax | 423-942-0146
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Provider Business Mailing Address
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Address Line | 4665 MAIN ST SUITE 2
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City | JASPER
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State | TN
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Zip | 37347
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Country | US
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Telephone | 423-942-0145
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Fax | 423-942-0146
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 22310
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 364SF0001X
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Taxonomy Name | Family Health Clinical Nurse Specialist
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License Number | 22310
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License Number State | TN
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