Provider Demographics
NPI:1427814490
Name:JORDAN, HOLLIN P (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:HOLLIN
Middle Name:P
Last Name:JORDAN
Suffix:
Gender:
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4106 COLLEGE DR APT 1004
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-7382
Mailing Address - Country:US
Mailing Address - Phone:936-671-3946
Mailing Address - Fax:
Practice Address - Street 1:4106 COLLEGE DR APT 1004
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901-7382
Practice Address - Country:US
Practice Address - Phone:936-671-3946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered