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General NPI Number Information
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NPI Number | 1235702259
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Entity Type | Individual
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Provider Name | JORDAN MIMBS
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Gender | Female
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Dates
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Enumeration Date | 07/19/2021
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Last Update Date | 07/19/2021
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Provider Practice Location Address
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Address Line | 151 SOUTHWEST DR
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City | JONESBORO
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State | AR
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Zip | 72401-5828
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Country | US
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Telephone | 870-932-0090
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Fax | 870-930-9336
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Provider Business Mailing Address
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Address Line | 100 HARPER DR
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City | BROOKLAND
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State | AR
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Zip | 72417-9063
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Country | US
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Telephone | 501-626-6484
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Fax |
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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 |
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License Number State |
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