Provider Demographics
NPI:1316623598
Name:MCCRACKEN, JORDAN ROCHELLE (FNP-BC)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:ROCHELLE
Last Name:MCCRACKEN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5275 STATE ROUTE 122 STE 100
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-9617
Mailing Address - Country:US
Mailing Address - Phone:513-424-7291
Mailing Address - Fax:
Practice Address - Street 1:5275 STATE ROUTE 122 STE 100
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-9617
Practice Address - Country:US
Practice Address - Phone:513-424-7291
Practice Address - Fax:513-424-2289
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0033902363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily