Individual
JORDAN FRAZIER SHELBURNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
2410 SUSANNAH ST, JOHNSON CITY, TN 37601-1748
(423) 282-9011
Mailing address
4213 ANCHOR PT, KINGSPORT, TN 37664-2986
(276) 337-0478
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
28750
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28750
STATE LICENSE
TN
Enumeration date
01/07/2021
Last updated
11/03/2021
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