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NPI Code Detail

MEDICARE: JORDAN NICOLE WHITE

MEDICARE: JORDAN NICOLE WHITE
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
1106S00000XBehavior Technician
2103K00000XBehavior Analyst1401177703VA

General Provider Information

NPI Number : 1174229249
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN NICOLE WHITE
Provider Business Mailing Address
First Line : 1138 2ND ST SW
Second Line :
City : ROANOKE
State : VA
Zip : 24016-4725
Country : US
Telephone Number : 540-739-7527
Fax Number :
Provider Business Practice Location Address
First Line : 1138 2ND ST SW
Second Line :
City : ROANOKE
State : VA
Zip : 24016-4725
Country : US
Telephone Number : 540-739-7527
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2023
Last Update Date : 10/31/2023

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Directions to “ JORDAN NICOLE WHITE ” Practice Location

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