Provider Demographics
NPI:1720094626
Name:JORDAN, JAIME T (NP)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:T
Last Name:JORDAN
Suffix:
Gender:F
Credentials:NP
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 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-6483
Mailing Address - Fax:682-885-3113
Practice Address - Street 1:6210 JOHN RYAN DR STE 104
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4111
Practice Address - Country:US
Practice Address - Phone:682-303-0800
Practice Address - Fax:682-303-0799
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX658598363LW0102X
TXAP114339363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Y0684OtherBCBS
TX181339601Medicaid
TXQ70831Medicare UPIN
TX8G7559Medicare PIN