Provider Demographics
NPI:1609545938
Name:WILSON, JORDAN REED (RN)
Entity Type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:REED
Last Name:WILSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:JORDAN
Other - Middle Name:WALLACE
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NA
Mailing Address - Street 1:PO BOX 2249
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35502-2249
Mailing Address - Country:US
Mailing Address - Phone:205-435-3764
Mailing Address - Fax:
Practice Address - Street 1:368 OLD FERRY RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35503-8154
Practice Address - Country:US
Practice Address - Phone:205-435-3764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-151796163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse