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General NPI Number Information
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NPI Number | 1053039388
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Entity Type | Individual
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Provider Name | JORDAN JENKINS
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Gender | Female
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Dates
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Enumeration Date | 08/22/2022
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Last Update Date | 08/22/2022
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Provider Practice Location Address
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Address Line | 501 E NORTHSIDE DR
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City | CLINTON
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State | MS
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Zip | 39056-3604
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Country | US
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Telephone | 601-924-0645
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Fax | 601-607-1375
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Provider Business Mailing Address
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Address Line | 599C STEED RD
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City | RIDGELAND
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State | MS
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Zip | 39157-1707
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Country | US
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Telephone | 601-605-6777
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Fax | 601-813-5460
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT7422
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License Number State | MS
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