MEDICARE: JORDAN HOLDER CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1-128558	AL

General Provider Information

NPI Number	:	1124529789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN HOLDER CRNP

Provider Business Mailing Address
First Line	:	310 W GRAND AVE
Second Line	:
City	:	RAINBOW CITY
State	:	AL
Zip	:	35906-3236
Country	:	US
Telephone Number	:	256-459-5132
Fax Number	:	256-459-5179

Provider Business Practice Location Address
First Line	:	310 W GRAND AVE
Second Line	:
City	:	RAINBOW CITY
State	:	AL
Zip	:	35906-3236
Country	:	US
Telephone Number	:	256-459-5132
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2018
Last Update Date	:	01/03/2023

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