Provider Demographics
NPI:1770036550
Name:KIMMET, JORDAN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:KIMMET
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:
Other - Last Name:SNOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1215 21ST AVENUE SOUTH
Mailing Address - Street 2:VANDERBILT AUTONOMIC DYSFUNCTION CLINIC
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-5492
Mailing Address - Country:US
Mailing Address - Phone:615-322-2318
Mailing Address - Fax:615-936-8208
Practice Address - Street 1:1215 21ST AVENUE SOUTH
Practice Address - Street 2:VANDERBILT AUTONOMIC DYSFUNCTION CLINIC
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-5492
Practice Address - Country:US
Practice Address - Phone:615-322-2318
Practice Address - Fax:615-936-8208
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN189055163W00000X
TN21193363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse