Healthcare Provider Details

I. General information

NPI: 1942114160
Provider Name (Legal Business Name): JORDAN CLEARMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 E MAIN ST STE 1
PHILADELPHIA MS
39350-2300
US

IV. Provider business mailing address

10340 HIGHWAY 491 N
PHILADELPHIA MS
39350-5426
US

V. Phone/Fax

Practice location:
  • Phone: 601-416-0519
  • Fax:
Mailing address:
  • Phone: 601-416-0519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number908544
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: