Keyana Tanie Jordan

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

A15383 Issued in NC

Practice address

4508 Crowne Lake Cir Apt 1D
Jamestown, NC 27282-7921

Phone

(252) 314-7403

NPI assigned

Sep 24, 2019

Last updated

Nov 23, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1569283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574467200000",
    "number": "1902457682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4508 CROWNE LAKE CIR APT 1D",
            "city": "JAMESTOWN",
            "state": "NC",
            "postal_code": "272827921",
            "telephone_number": "252-314-7403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4508 CROWNE LAKE CIR APT 1D",
            "city": "JAMESTOWN",
            "state": "NC",
            "postal_code": "272827921",
            "telephone_number": "252-314-7403"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4508 Crowne Lake Cir Apt 1D",
            "address_purpose": "LOCATION",
            "city": "Jamestown",
            "state": "NC",
            "postal_code": "272827921",
            "country_code": "US",
            "telephone_number": "252-314-7403",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "KEYANA",
        "middle_name": "TANIE",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-24",
        "last_updated": "2019-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "LCAS-25905",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "A15383",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Jamestown, NC
• Providers in Jamestown, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.