Provider Demographics
NPI:1972157402
Name:JORDAN, VALERIE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:
Other - Last Name:BERGERON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8707 ASHEVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37924-4502
Mailing Address - Country:US
Mailing Address - Phone:865-933-4159
Mailing Address - Fax:
Practice Address - Street 1:8707 ASHEVILLE HWY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37924-4502
Practice Address - Country:US
Practice Address - Phone:865-933-4159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26180363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ087666Medicaid