Provider Demographics
NPI:1902332497
Name:JORDAN, ERICA L (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:L
Last Name:JORDAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 KENTON ST STE 1B
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-1981
Mailing Address - Country:US
Mailing Address - Phone:270-886-8840
Mailing Address - Fax:
Practice Address - Street 1:1914 S VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-3610
Practice Address - Country:US
Practice Address - Phone:270-220-0360
Practice Address - Fax:270-220-0369
Is Sole Proprietor?:No
Enumeration Date:2017-05-03
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011299363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner