Provider Demographics
NPI:1629351465
Name:CALLAHAN, JORDAN (CPM-TN)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:CPM-TN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 TIMBER VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-4236
Mailing Address - Country:US
Mailing Address - Phone:704-965-2343
Mailing Address - Fax:
Practice Address - Street 1:1341 TIMBER VALLEY DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-4236
Practice Address - Country:US
Practice Address - Phone:615-601-1079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNCPM0000000058176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife