Provider Demographics
NPI:1447782354
Name:GIBBLE, JORDAN (FNP)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:GIBBLE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:
Other - Last Name:FAYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:113 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:NC
Mailing Address - Zip Code:28398-1924
Mailing Address - Country:US
Mailing Address - Phone:910-293-7246
Mailing Address - Fax:910-267-8988
Practice Address - Street 1:113 S PINE ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NC
Practice Address - Zip Code:28398-1924
Practice Address - Country:US
Practice Address - Phone:910-293-7246
Practice Address - Fax:910-267-8988
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC292012363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily