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General NPI Number Information
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NPI Number | 1811879372
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Entity Type | Individual
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Provider Name | JORDAN ELISHA FONDREN JOHNSON BA
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Gender | Female
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Dates
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Enumeration Date | 07/24/2025
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 424 CHURCH ST STE 2000
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City | NASHVILLE
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State | TN
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Zip | 37219-3304
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Country | US
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Telephone | 615-854-7535
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Fax |
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Provider Business Mailing Address
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Address Line | 1335 BRADYVILLE PIKE APT D102
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City | MURFREESBORO
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State | TN
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Zip | 37130-5675
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Country | US
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Telephone | 629-772-0881
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | TN
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