Provider Demographics
NPI:1922663822
Name:JORDAN, NICOLAS MICHAEL
Entity type:Individual
Prefix:
First Name:NICOLAS
Middle Name:MICHAEL
Last Name:JORDAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8004 DENTON HWY STE 108
Mailing Address - Street 2:
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76148-2469
Mailing Address - Country:US
Mailing Address - Phone:405-436-6414
Mailing Address - Fax:
Practice Address - Street 1:8004 DENTON HWY STE 108
Practice Address - Street 2:
Practice Address - City:WATAUGA
Practice Address - State:TX
Practice Address - Zip Code:76148-2469
Practice Address - Country:US
Practice Address - Phone:404-436-6414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK71322084P0800X
FLOS220452084P0800X
TXV64882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry