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General NPI Number Information
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NPI Number | 1902332497
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Entity Type | Individual
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Provider Name | ERICA L JORDAN APRN
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Gender | Female
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Dates
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Enumeration Date | 05/03/2017
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Last Update Date | 06/28/2021
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Provider Practice Location Address
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Address Line | 1914 S VIRGINIA ST
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City | HOPKINSVILLE
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State | KY
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Zip | 42240-3610
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Country | US
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Telephone | 270-220-0360
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Fax | 270-220-0369
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Provider Business Mailing Address
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Address Line | 1724 KENTON ST STE 1B
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City | HOPKINSVILLE
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State | KY
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Zip | 42240-1981
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Country | US
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Telephone | 270-886-8840
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 3011299
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License Number State | KY
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