Healthcare Provider Details

I. General information

NPI: 1841829074
Provider Name (Legal Business Name): JORDAN BEALE LUTTRELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 N DUNLAP ST
MEMPHIS TN
38105-4624
US

IV. Provider business mailing address

910 MADISON AVE STE 401
MEMPHIS TN
38103-3403
US

V. Phone/Fax

Practice location:
  • Phone: 866-870-5570
  • Fax:
Mailing address:
  • Phone: 901-448-5885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number246910
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: