Provider Demographics
NPI:1013284041
Name:STEPHENS, JORDAN E (FNP-BC, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:E
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:FNP-BC, 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:PO BOX 2131
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-2131
Mailing Address - Country:US
Mailing Address - Phone:530-220-3180
Mailing Address - Fax:
Practice Address - Street 1:630 KINGS CT
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5003
Practice Address - Country:US
Practice Address - Phone:707-468-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA797559163W00000X
WARN61631992163W00000X
CA80660163WC1500X
CA23112363L00000X, 363LP0808X, 363LF0000X
WAAP61631994363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health