Provider Demographics
NPI:1174355903
Name:WILLIAMS, JORDAN NICOLE (RN)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:NICOLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 GREENBRIER DR
Mailing Address - Street 2:
Mailing Address - City:VAN ALSTYNE
Mailing Address - State:TX
Mailing Address - Zip Code:75495-7079
Mailing Address - Country:US
Mailing Address - Phone:918-527-6647
Mailing Address - Fax:
Practice Address - Street 1:120 BRENTWOOD COMMONS WAY STE 510
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-2028
Practice Address - Country:US
Practice Address - Phone:817-919-3557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1157808163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse