Active NPI
Kimberly Nacole Jordan
- Occupational Therapist
- Fort Deposit, AL
National Provider Identifier
1508230988
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 3721
- Practice address
- 435 Pine St
Fort Deposit, AL 36032-4740 - Phone
- (334) 833-2396
- NPI assigned
- Nov 22, 2015
- Last updated
- Nov 22, 2015
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 3721 | AL | Primary |
Addresses
Primary practice location
435 Pine St
Fort Deposit, AL 36032-4740
Mailing address
PO Box 582
435 Pine Street
Fort Deposit, AL 36032-0582
Phone (334) 833-2396
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3721 | AL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1448150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1448150400000",
"number": "1508230988",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 582",
"address_2": "435 PINE STREET",
"city": "FORT DEPOSIT",
"state": "AL",
"postal_code": "360320582",
"telephone_number": "334-833-2396"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "435 PINE ST",
"city": "FORT DEPOSIT",
"state": "AL",
"postal_code": "360324740",
"telephone_number": "334-833-2396"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORDAN",
"first_name": "KIMBERLY",
"middle_name": "NACOLE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-11-22",
"last_updated": "2015-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "AL",
"license": "3721",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Deposit, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.