Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | P2750 | TN |
NPI | 1104929199 |
---|---|
Provider Name | Dr. Nancy E Jordan |
First Address | Memphis, TN 38104-2127 |
Second Address | Memphis, TN 38104-2127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 06/11/2013 |