Provider Demographics
NPI:1447647581
Name:JORDAN, TAMEKA P (DHSC, PHD, CHES)
Entity type:Individual
Prefix:DR
First Name:TAMEKA
Middle Name:P
Last Name:JORDAN
Suffix:
Gender:F
Credentials:DHSC, PHD, CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14444 SUMMERSET DR
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-7087
Mailing Address - Country:US
Mailing Address - Phone:225-255-1217
Mailing Address - Fax:
Practice Address - Street 1:1929 W AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-3353
Practice Address - Country:US
Practice Address - Phone:225-255-1217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 133NN1002X, 174400000X, 174H00000X, 225400000X
LA149322083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No174400000XOther Service ProvidersSpecialist
No174H00000XOther Service ProvidersHealth Educator
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner