Provider Demographics
NPI:1417348905
Name:JORDAN, JEREMY DUGGER (CRNP, CPNP-AC)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:DUGGER
Last Name:JORDAN
Suffix:
Gender:M
Credentials:CRNP, CPNP-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 2ND AVE S # NB308
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35294-1210
Mailing Address - Country:US
Mailing Address - Phone:205-996-3651
Mailing Address - Fax:205-996-7177
Practice Address - Street 1:1600 7TH AVE S
Practice Address - Street 2:CPPI 102
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1711
Practice Address - Country:US
Practice Address - Phone:205-638-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-136533163W00000X, 363LP0200X
AL1-135633363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics