Provider Demographics
NPI:1851116172
Name:JORDAN, MELINDA LEE (MSN, RN)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:LEE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4133 CRAIG DR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5551
Mailing Address - Country:US
Mailing Address - Phone:325-518-1784
Mailing Address - Fax:
Practice Address - Street 1:4133 CRAIG DR
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5551
Practice Address - Country:US
Practice Address - Phone:325-518-1784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX736727163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse