Provider Demographics
NPI:1124845219
Name:JORDAN, ANITA SUE (MSN, APRN, PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:SUE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 JOE BYRD LN
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:TN
Mailing Address - Zip Code:37716-5441
Mailing Address - Country:US
Mailing Address - Phone:865-805-9296
Mailing Address - Fax:
Practice Address - Street 1:17 RIDGEWAY RD
Practice Address - Street 2:
Practice Address - City:NORRIS
Practice Address - State:TN
Practice Address - Zip Code:37828-3071
Practice Address - Country:US
Practice Address - Phone:865-234-4352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36973363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health