Provider Demographics
NPI:1639840085
Name:HUMPHREY, JORDAN CATHERINE (APRN)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:CATHERINE
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8715 VILLAGE DR STE 518
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5423
Mailing Address - Country:US
Mailing Address - Phone:210-590-7712
Mailing Address - Fax:
Practice Address - Street 1:8715 VILLAGE DR STE 518
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5423
Practice Address - Country:US
Practice Address - Phone:210-590-7712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-24
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK178473363LA2100X
TX1086449363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care