Individual
MR. CHARLES JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
2108 W WASHINGTON ST STE 100, STEPHENVILLE, TX 76401-3928
(254) 587-3848
Mailing address
2350 HIGHWAY 16, DE LEON, TX 76444-6411
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP141070
TX
363LF0000X
Family Nurse Practitioner
848612
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1679033476
—
TX
Enumeration date
03/20/2019
Last updated
02/05/2024
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