Individual
MRS. MIRANDA LYALLS JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
310 HOSPITAL AVE, JEFFERSON, NC 28640
(336) 846-6322
Mailing address
266 WITHERSPOON HEIGHTS RD, JEFFERSON, NC 28640-9043
(336) 977-9724
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
5011326
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1619907334
—
NC
Enumeration date
01/03/2019
Last updated
01/03/2019
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