Antionette Jordan

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

2022047351 Issued in MO

Practice address

10004 Kennerly Rd Ste 374B
Saint Louis, MO 63128-2178

Phone

(314) 842-9669

Fax

(314) 842-1017

NPI assigned

Jan 24, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

NHS South LLCGroup PAC ID 1658797246, 9 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• SSM Health St Mary'S Hospital - St Louis Hospital, Saint Louis, MO, CCN 260091
• Christian Hospital Northeast Hospital, Saint Louis, MO, CCN 260180
• SSM Health Depaul Hospital St Louis Hospital, Bridgeton, MO, CCN 260104

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• NHS South LLC

  • Nephrology Physician
  • Saint Louis, MO
  • NPI 1376166066
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Christian Hospital Northeast- Northwest

  • General Acute Care Hospital
  • Saint Louis, MO
  • NPI 1639186760
  Care Compare affiliation
• Christian Hospital Northeast-Northwest

  • Ambulance
  • Saint Louis, MO
  • NPI 1073769329

  Hospital

  Care Compare affiliation
• SSM Health Care St. Louis

  • General Acute Care Hospital
  • Saint Louis, MO
  • NPI 1336387836
  Care Compare affiliation
• SSM Health Care St. Louis

  • General Acute Care Hospital
  • Bridgeton, MO
  • NPI 1598835308
  Care Compare affiliation
• SSM Health Care St. Louis

  • General Acute Care Hospital
  • Saint Louis, MO
  • NPI 1962572396
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1674518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691280000000",
    "number": "1275249237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 802841",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641802841",
            "telephone_number": "314-842-9669",
            "fax_number": "314-842-1017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10004 KENNERLY RD STE 374B",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282178",
            "telephone_number": "314-842-9669",
            "fax_number": "314-842-1017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "ANTIONETTE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-24",
        "last_updated": "2023-08-06",
        "certification_date": "2023-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MO",
            "license": "2022047351",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "2022047351",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "420120169",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Iam Jophiel, LCSW
• Jordan Balter P.C.
• Sabrina Danise Jordan-Childs, M.D.
• Allison Elizabeth Jordan, M.D.
• Angelia Denise Jordan
• Antionette Jordan
• James Matthew Jordan, OCCUPATIONAL THERAPI
• Jody M Jordan
• Katelyn L Jordan
• Nina Jordan

• Nurse Practitioner in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.