Provider Demographics
NPI:1417470857
Name:GARRY, JORDAN (FNP)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:GARRY
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 1:7710 MERCY RD STE 426
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2323
Mailing Address - Country:US
Mailing Address - Phone:402-343-8650
Mailing Address - Fax:402-343-8545
Practice Address - Street 1:7710 MERCY RD STE 426
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2323
Practice Address - Country:US
Practice Address - Phone:402-343-8650
Practice Address - Fax:402-343-8545
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342049363LF0000X
NJ26NJ01207200363LF0000X
IAA181313363LF0000X
NE115329363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily