Provider Demographics
NPI:1871286989
Name:ROUNDTREE, JORDAN (APRN, PMHNP)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:ROUNDTREE
Suffix:
Gender:M
Credentials:APRN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 PUBLIC SQ STE E-104
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-2871
Mailing Address - Country:US
Mailing Address - Phone:931-288-4619
Mailing Address - Fax:931-208-4063
Practice Address - Street 1:142 PUBLIC SQ STE E-104
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2871
Practice Address - Country:US
Practice Address - Phone:931-288-4619
Practice Address - Fax:931-208-4063
Is Sole Proprietor?:No
Enumeration Date:2023-06-02
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34146363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health