Healthcare Provider Details

I. General information

NPI: 1295533941
Provider Name (Legal Business Name): JORDAN NEELEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 E CHURCH ST
WARREN AR
71671-3528
US

IV. Provider business mailing address

327 NEELEY RD
DUMAS AR
71639-9556
US

V. Phone/Fax

Practice location:
  • Phone: 870-226-5856
  • Fax:
Mailing address:
  • Phone: 870-377-3088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberA2512005A
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: