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NPI Code Detail

MEDICARE: EVERGREEN BEHAVIORAL HEALTH & WELLNESS, PLLC

MEDICARE: EVERGREEN BEHAVIORAL HEALTH & WELLNESS, PLLC
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
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1669346482
Entity Type Code : Organization
Provider Name (Legal Business Name) : EVERGREEN BEHAVIORAL HEALTH & WELLNESS, PLLC
Provider Business Mailing Address
First Line : 604 E FRONT ST UNIT 382
Second Line :
City : CLAYTON
State : NC
Zip : 27520-2058
Country : US
Telephone Number : 919-897-7538
Fax Number :
Provider Business Practice Location Address
First Line : 4030 WAKE FOREST RD STE 349
Second Line :
City : RALEIGH
State : NC
Zip : 27609-0010
Country : US
Telephone Number : 919-897-7538
Fax Number :
Authorized Official
Title or Position : OWNER/PHYSICIAN ASSISTANT
Name : JOSEPH JORDAN
Credential : PA-C
Telephone Number : 570-417-6508
Provider Enumeration Date : 10/03/2025
Last Update Date : 12/09/2025

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