Provider Demographics
NPI:1568022077
Name:JORDAN, JESSICA OLSEN
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:OLSEN
Last Name:JORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24450 EMILY WAY
Mailing Address - Street 2:
Mailing Address - City:HOCKLEY
Mailing Address - State:TX
Mailing Address - Zip Code:77447-5259
Mailing Address - Country:US
Mailing Address - Phone:281-667-2015
Mailing Address - Fax:
Practice Address - Street 1:1905 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340
Practice Address - Country:US
Practice Address - Phone:281-667-2015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX951835163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse