Provider Demographics
NPI:1225658222
Name:CORPIER, JORDAN DAVIS (RN)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:DAVIS
Last Name:CORPIER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4631 OLD HIGHWAY 135
Mailing Address - Street 2:
Mailing Address - City:GLADEWATER
Mailing Address - State:TX
Mailing Address - Zip Code:75647-5630
Mailing Address - Country:US
Mailing Address - Phone:903-808-5617
Mailing Address - Fax:
Practice Address - Street 1:4631 OLD HIGHWAY 135
Practice Address - Street 2:
Practice Address - City:GLADEWATER
Practice Address - State:TX
Practice Address - Zip Code:75647-5630
Practice Address - Country:US
Practice Address - Phone:903-808-5617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX983445163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse