Provider Demographics
NPI:1730650326
Name:JORDAN, KATHERINE CROSS (MS, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:CROSS
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2807 GREYSTONE COMMERCIAL BLVD STE 36
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-9601
Mailing Address - Country:US
Mailing Address - Phone:205-478-2176
Mailing Address - Fax:
Practice Address - Street 1:2807 GREYSTONE COMMERCIAL BLVD STE 36
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-9601
Practice Address - Country:US
Practice Address - Phone:205-478-2176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-08
Last Update Date:2018-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL86049201133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered