Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | 1-140593 | AL |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 1-140593 | AL |
Y | 363LG0600X | Nurse Practitioner - Gerontology | 1-140593 | AL |
NPI | 1609347574 |
---|---|
Provider Name | Jordan Tyler Chambers |
First Address | Birmingham, AL 35255-5310 |
Second Address | Birmingham, AL 35249-1932 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2018 |
Last Update Date | 06/02/2019 |