Provider Demographics
NPI:1801851738
Name:JORDAN, BEVERLY A (FNP)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:A
Last Name:JORDAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 530062
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-0062
Mailing Address - Country:US
Mailing Address - Phone:843-695-6071
Mailing Address - Fax:843-569-5879
Practice Address - Street 1:5325 APPIAN WAY
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-7234
Practice Address - Country:US
Practice Address - Phone:843-552-0400
Practice Address - Fax:843-552-1618
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1370363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0515Medicaid
SCAA45257006Medicare PIN
SCAA45256882Medicare PIN
SCAA45258798Medicare PIN
P42268Medicare UPIN