Provider Demographics
NPI:1811879372
Name:FONDREN JOHNSON, JORDAN ELISHA (BA)
Entity type:Individual
Prefix:MS
First Name:JORDAN
Middle Name:ELISHA
Last Name:FONDREN JOHNSON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 BRADYVILLE PIKE APT D102
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-5675
Mailing Address - Country:US
Mailing Address - Phone:629-772-0881
Mailing Address - Fax:
Practice Address - Street 1:424 CHURCH ST STE 2000
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37219-3304
Practice Address - Country:US
Practice Address - Phone:615-854-7535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician