Provider Demographics
NPI:1023253259
Name:JORDAN, KRYSTAL NICOLE (LVN)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:NICOLE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LVN
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 300324
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77230-0324
Mailing Address - Country:US
Mailing Address - Phone:713-847-0258
Mailing Address - Fax:
Practice Address - Street 1:7943 GLENBRAE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77061-2307
Practice Address - Country:US
Practice Address - Phone:713-847-0258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206799164X00000X
TX815113163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse