Provider Demographics
NPI:1831113059
Name:JORDAN, IRMA L (DNP, FNP/PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:IRMA
Middle Name:L
Last Name:JORDAN
Suffix:
Gender:F
Credentials:DNP, FNP/PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:877 MADISON AVE # 663
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-3408
Mailing Address - Country:US
Mailing Address - Phone:901-448-6161
Mailing Address - Fax:901-448-4121
Practice Address - Street 1:4829 S COTTAGE GROVE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-1600
Practice Address - Country:US
Practice Address - Phone:773-548-1170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5186363L00000X
IL209.021887363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3904471Medicaid
TN3904471Medicaid
TNS90414Medicare UPIN