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General NPI Number Information
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NPI Number | 1679033476
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Entity Type | Individual
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Provider Name | CHARLES JORDAN FNP-C
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Gender | Male
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Dates
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Enumeration Date | 03/20/2019
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 2108 W WASHINGTON ST STE 100
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City | STEPHENVILLE
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State | TX
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Zip | 76401-3928
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Country | US
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Telephone | 254-587-3848
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Fax |
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Provider Business Mailing Address
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Address Line | 2350 HIGHWAY 16
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City | DE LEON
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State | TX
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Zip | 76444-6411
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 848612
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP141070
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License Number State | TX
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