Healthcare Provider Details

I. General information

NPI: 1457271116
Provider Name (Legal Business Name): JORDYN LEXUS SHEARRER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 N WESTWOOD BLVD
POPLAR BLUFF MO
63901-3336
US

IV. Provider business mailing address

153 HARRIS AVE
POPLAR BLUFF MO
63901-7483
US

V. Phone/Fax

Practice location:
  • Phone: 573-785-7751
  • Fax:
Mailing address:
  • Phone: 573-718-4265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number2026013804
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: