Provider Demographics
NPI:1164143061
Name:JORDAN, TENESSA KAY (BSN)
Entity Type:Individual
Prefix:
First Name:TENESSA
Middle Name:KAY
Last Name:JORDAN
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 HARVEY AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3006
Mailing Address - Country:US
Mailing Address - Phone:513-585-8306
Mailing Address - Fax:
Practice Address - Street 1:3131 HARVEY AVE STE 104
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3006
Practice Address - Country:US
Practice Address - Phone:513-585-8306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.458143163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)