Individual provider Active NPI

Brandi Foster Jordan, N.P.

  • Pediatric Nurse Practitioner
  • Kernersville, NC
National Provider Identifier
1417299603
Registry record updated Mar 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
5006126 Issued in NC
Practice address
861 Old Winston Rd
Kernersville, NC 27284-7140
Phone
(336) 802-2536
Fax
(336) 802-2534
NPI assigned
Mar 26, 2013
Last updated
Mar 26, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 5006126 NC Primary

Addresses

Primary practice location

861 Old Winston Rd
Kernersville, NC 27284-7140

Mailing address

1701 Westchester Dr
Suite 850
High Point, NC 27262-7008
Phone (336) 802-2536

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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

Enrollment IDStateProvider typePAC IDDetails
I20130528000463 NC Practitioner - Nurse Practitioner 5597903880 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Forest Health Network, LLC CurrentSince Jul 7, 2023 Accepting new patients
Wake Forest Health Network LLC Current Accepting new patients
Wake Forest Health Network LLC CurrentSince Jul 7, 2023 Accepting new patients
Cornerstone Health Care PA Past Accepting new patients
Wake Forest Health Network LLC Past Accepting new patients

Locations

1701 Westchester Dr
Ste 850
High Point, NC 27262
Phone (336) 802-2400

905 Phillips Ave
High Point, NC 27262
Phone (336) 802-2040

861 Old Winston Rd
Ste 103
Kernersville, NC 27284
Phone (336) 802-2300

100 Kimel Forest Dr
Winston Salem, NC 27103
Phone (336) 713-0947

3333 Brookview Hills Blvd
Ste 102
Winston Salem, NC 27103
Phone (336) 760-1448

Organizations & group practices 5

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

NPI Registry JSON

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

{
    "created_epoch": "1364256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1364256000000",
    "number": "1417299603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 WESTCHESTER DR",
            "address_2": "SUITE 850",
            "city": "HIGH POINT",
            "state": "NC",
            "postal_code": "272627008",
            "telephone_number": "336-802-2536",
            "fax_number": "336-802-2534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "861 OLD WINSTON RD",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272847140",
            "telephone_number": "336-802-2536",
            "fax_number": "336-802-2534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "BRANDI",
        "middle_name": "FOSTER",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-26",
        "last_updated": "2013-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NC",
            "license": "5006126",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kernersville, NC

Sources for this page

Verify at the official NPI Registry.