Individual
JORDAN MALLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5600 SE 67TH ST STE 200, OKLAHOMA CITY, OK 73135-1719
(405) 455-4020
Mailing address
1707 PINON LN, JACKSONVILLE, AR 72076-3423
(501) 413-2094
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/07/2024
Last updated
09/23/2024
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