Individual
JORDAN LARUE FULCHER JENKINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
111 KELLY BLVD, MADISON, MS 39110-1206
(601) 898-6080
Mailing address
502 FAWN CV, CANTON, MS 39046-9417
(601) 919-5150
(888) 240-6288
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
903027
MS
Other
Enumeration date
11/15/2018
Last updated
04/29/2024
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