Active NPI
Jordan Blair Huffman Coggin
- Family Nurse Practitioner
- Charlotte, NC
National Provider Identifier
1366844516
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 5007186
- Practice address
- 1717 Sharon Rd W
Charlotte, NC 28210-5663 - Phone
- (980) 222-4692
- Fax
- (704) 892-9324
- NPI assigned
- Sep 18, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 5007186 | NC | Primary |
Addresses
Primary practice location
1717 Sharon Rd W
Charlotte, NC 28210-5663
Mailing address
10311 Calaveras CT
Huntersville, NC 28078-6497
Phone (704) 239-5982
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 1, 2023 through Oct 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5007186 | NC | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1410998400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721260800000",
"number": "1366844516",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10311 CALAVERAS CT",
"city": "HUNTERSVILLE",
"state": "NC",
"postal_code": "280786497",
"telephone_number": "704-239-5982"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1717 SHARON RD W",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282105663",
"telephone_number": "980-222-4692",
"fax_number": "704-892-9324"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COGGIN",
"first_name": "JORDAN",
"middle_name": "BLAIR HUFFMAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-09-18",
"last_updated": "2024-07-18",
"certification_date": "2024-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "NC",
"license": "5007186",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.