MEDICARE: MRS. DENISE ANN JORDAN LPN, HIM, NASM FNS

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	364SC1501X	Community Health/Public Health Clinical Nurse Specialist	20160917	LA
2	171400000X	Health & Wellness Coach	20160917	LA
3	133NN1002X	Nutrition Education Nutritionist	20160917	LA
4	2470A2800X	Assistant Health Information Record Technician	20160917	LA
5	164W00000X	Licensed Practical Nurse	20160917	LA
6	364SI0800X	Informatics Clinical Nurse Specialist	20160917	LA
7	171M00000X	Case Manager/Care Coordinator	20160917	LA

General Provider Information

NPI Number	:	1235092321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DENISE ANN JORDAN LPN, HIM, NASM FNS

Provider Business Mailing Address
First Line	:	402 KELSEA DR
Second Line	:
City	:	BROUSSARD
State	:	LA
Zip	:	70518-4966
Country	:	US
Telephone Number	:	337-654-2595
Fax Number	:	225-439-3099

Provider Business Practice Location Address
First Line	:	402 KELSEA DR
Second Line	:
City	:	BROUSSARD
State	:	LA
Zip	:	70518-4966
Country	:	US
Telephone Number	:	337-654-2595
Fax Number	:	225-439-3099

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

Provider Enumeration Date	:	12/05/2025
Last Update Date	:	12/05/2025

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