Individual
MALLORY ODOM JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
27 S SIXTH ST, BAY SPRINGS, MS 39422-9052
(601) 764-2155
Mailing address
27 S SIXTH ST, BAY SPRINGS, MS 39422-9052
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
904891
MS
Other
Enumeration date
10/02/2021
Last updated
10/02/2021
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