Individual provider · NPI-1

Mallory Odom Jordan, FNP

Nurse Practitioner, Family · Bay Springs, MS

NPI number1073285573
StatusActive
Last updated in NPPESOct 2, 2021

Details

NPI
1073285573
Entity type
Individual (NPI-1)
Name
Mallory Odom Jordan
Credential
FNP
Sex
Female
Sole proprietor
No
Enumeration date
Oct 2, 2021
Certification date
Oct 2, 2021
Last updated
Oct 2, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363LF0000X Nurse Practitioner, Family904891MSYes

Practice location

27 S Sixth St
Bay Springs, MS 39422-9052

Phone 601-764-2155

Mailing address

27 S Sixth St
Bay Springs, MS 39422-9052

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