Individual
MRS. LESLIE ALLEN JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
4421 AUDUBON PARK DR, JACKSON, MS 39211-6136
(601) 927-4845
Mailing address
4421 AUDUBON PARK DR, JACKSON, MS 39211-6136
(601) 927-4845
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
901912
MS
390200000X
Student in an Organized Health Care Education/Training Program
390200000X
—
Other
Enumeration date
09/01/2021
Last updated
08/08/2024
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