Provider Demographics
NPI:1609347574
Name:CHAMBERS, JORDAN TYLER (ACNPC-AG)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:TYLER
Last Name:CHAMBERS
Suffix:
Gender:M
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:J
Other - Middle Name:TYLER
Other - Last Name:CHAMBERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 55310
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5310
Mailing Address - Country:US
Mailing Address - Phone:205-731-9701
Mailing Address - Fax:
Practice Address - Street 1:619 19TH ST S # OHB251
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35249-1932
Practice Address - Country:US
Practice Address - Phone:205-996-5111
Practice Address - Fax:205-930-7176
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-140593363LA2100X, 363LC0200X, 363LF0000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily