MEDICARE: DR. IRMA L JORDAN DNP, FNP/PMHNP-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
1	363L00000X	Nurse Practitioner	5186	TN
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	209.021887	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831113059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRMA L JORDAN DNP, FNP/PMHNP-BC

Provider Business Mailing Address
First Line	:	877 MADISON AVE # 663
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38103-3408
Country	:	US
Telephone Number	:	901-448-6161
Fax Number	:	901-448-4121

Provider Business Practice Location Address
First Line	:	4829 S COTTAGE GROVE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-1600
Country	:	US
Telephone Number	:	773-548-1170
Fax Number	:

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	10/16/2020

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