Individual
DOMONIQUE JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN, PMHNP-BC
Contact information
Practice address
115 E MAIN ST # 1030, GRAND PRAIRIE, TX 75050-5722
(469) 616-0232
Mailing address
2627 HARLOW LN, GRAND PRAIRIE, TX 75052-8930
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2023194429
TX
Other
Enumeration date
06/05/2024
Last updated
07/12/2024
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