Individual
AMANDA T. JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OGNP
Contact information
Practice address
114 E PRESLEY BLVD, MCCOMB, MS 39648-5908
(601) 684-1030
(601) 684-5999
Mailing address
7510 MOAK RD, SUMMIT, MS 39666-7580
(601) 684-1205
(601) 684-1205
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
R575623
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00124011
—
MS
Enumeration date
01/02/2007
Last updated
07/09/2007
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