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NPI Code Detail

MEDICARE: JORDAN MARIE PRIEST DNP, FNP-BC

MEDICARE: JORDAN MARIE PRIEST DNP, FNP-BC
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
1363LF0000XFamily Nurse Practitioner2022028516MO

General Provider Information

NPI Number : 1790410751
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN MARIE PRIEST DNP, FNP-BC
Provider Business Mailing Address
First Line : 1050 W 10TH ST
Second Line :
City : ROLLA
State : MO
Zip : 65401-2905
Country : US
Telephone Number : 573-364-9000
Fax Number :
Provider Business Practice Location Address
First Line : 1000 N JEFFERSON ST
Second Line :
City : SAINT JAMES
State : MO
Zip : 65559-1078
Country : US
Telephone Number : 573-265-8840
Fax Number : 573-202-2474
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2022
Last Update Date : 03/25/2024

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