Miranda Lyalls Jordan, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

5011326 Issued in NC

Practice address

310 Hospital Ave
Jefferson, NC 28640

Phone

(336) 846-6322

NPI assigned

Jan 3, 2019

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 1

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

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Margate Health and Rehab Center LLC

  • Rehabilitation Hospital Unit
  • Jefferson, NC
  • NPI 1871163519
  NPD (past)

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

{
    "created_epoch": "1546473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546473600000",
    "number": "1457824393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "266 WITHERSPOON HEIGHTS RD",
            "city": "JEFFERSON",
            "state": "NC",
            "postal_code": "286409043",
            "telephone_number": "336-977-9724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 HOSPITAL AVE",
            "city": "JEFFERSON",
            "state": "NC",
            "postal_code": "28640",
            "telephone_number": "336-846-6322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "MIRANDA",
        "middle_name": "LYALLS",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-03",
        "last_updated": "2019-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5011326",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1619907334",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joel W. Yates Jr. D.D.S. P.L.L.C
• John a Sundin MD Endoscopy Unit (John A Sundin MD)
• Charles B Jones Jr., PA
• Charles Wade Jones, MD
• Robin Jones, RN
• Jennifer Archer Keely, MA, LMFT, LCAS
• Michael Avery Kepley, M.D.
• Ayla Kessler, MD
• Emily Kesterson
• Jessica Kimball

• Family Nurse Practitioner in Jefferson, NC
• Providers in Jefferson, NC by specialty
• Family Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.