Individual
JORDAN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
3555 S NATIONAL AVE, SPRINGFIELD, MO 65807-7310
(000) 000-0000
Mailing address
3555 S NATIONAL AVE, SPRINGFIELD, MO 65807-7310
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
2024004279
MO
363LG0600X
Gerontology Nurse Practitioner
2024004279
MO
Other
Enumeration date
04/29/2024
Last updated
01/02/2026
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