Provider Demographics
NPI:1275631210
Name:JORDAN, JESSICA (CNM)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 LIBBY TERRACE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-2910
Mailing Address - Country:US
Mailing Address - Phone:804-649-2001
Mailing Address - Fax:804-344-3379
Practice Address - Street 1:2910 LIBBY TER
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-7908
Practice Address - Country:US
Practice Address - Phone:804-649-2001
Practice Address - Fax:804-344-3379
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024120283367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife