Provider Demographics
NPI:1386028488
Name:DYER, JORDAN L (FNP)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:L
Last Name:DYER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 316
Mailing Address - Street 2:
Mailing Address - City:CORRYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37721-0316
Mailing Address - Country:US
Mailing Address - Phone:865-992-3031
Mailing Address - Fax:865-992-8103
Practice Address - Street 1:7701 CORRYTON RD
Practice Address - Street 2:
Practice Address - City:CORRYTON
Practice Address - State:TN
Practice Address - Zip Code:37721-2630
Practice Address - Country:US
Practice Address - Phone:865-992-3031
Practice Address - Fax:865-992-8103
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20160363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily