Healthcare Provider Details

I. General information

NPI: 1962385609
Provider Name (Legal Business Name): JORDAN HALEY CLAASSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 ROSS CLARK CIR STE 400
DOTHAN AL
36301-4770
US

IV. Provider business mailing address

PO BOX 2266
DOTHAN AL
36302-2266
US

V. Phone/Fax

Practice location:
  • Phone: 334-305-0400
  • Fax: 334-305-0401
Mailing address:
  • Phone: 334-305-0400
  • Fax: 334-305-0401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-183288
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: