Provider Demographics
NPI:1144650623
Name:JORDAN, BRANDI (MS, RD, LDN, IBCLC)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MS, RD, LDN, IBCLC
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:
Other - Last Name:PIGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LDN
Mailing Address - Street 1:12620 CREEKSIDE LAKE CV
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-1521
Mailing Address - Country:US
Mailing Address - Phone:573-429-8902
Mailing Address - Fax:
Practice Address - Street 1:12620 CREEKSIDE LAKE CV
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38002-1521
Practice Address - Country:US
Practice Address - Phone:573-429-8902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-19
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2588133VN1004X
L-96583174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric