Provider Demographics
NPI:1629621743
Name:PRICE, JORDAN BRYANT (DNP, APRN, AGNP-C)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:BRYANT
Last Name:PRICE
Suffix:
Gender:F
Credentials:DNP, APRN, AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GAVOTTE LN
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-8205
Mailing Address - Country:US
Mailing Address - Phone:864-261-7474
Mailing Address - Fax:
Practice Address - Street 1:100 GAVOTTE LN
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-8205
Practice Address - Country:US
Practice Address - Phone:864-261-7474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23000363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner