Provider Demographics
NPI:1255006722
Name:DAVIDSON, JORDAN (FNP-C)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:581 NOMOE RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL
Mailing Address - State:AR
Mailing Address - Zip Code:71968-9752
Mailing Address - Country:US
Mailing Address - Phone:501-385-7280
Mailing Address - Fax:
Practice Address - Street 1:581 NOMOE RD
Practice Address - Street 2:
Practice Address - City:ROYAL
Practice Address - State:AR
Practice Address - Zip Code:71968-9752
Practice Address - Country:US
Practice Address - Phone:501-385-7280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR216997363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily