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General NPI Number Information
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NPI Number | 1245045418
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Entity Type | Individual
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Provider Name | G LYNNETTE JORDAN
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Gender | Female
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Dates
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Enumeration Date | 02/12/2025
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Last Update Date | 11/06/2025
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Provider Practice Location Address
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Address Line | 712 W 3RD ST
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City | LITTLE ROCK
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State | AR
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Zip | 72201-2220
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Country | US
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Telephone | 501-379-4246
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Fax |
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Provider Business Mailing Address
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Address Line | 16401 CHENAL VALLEY DR APT 3203
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City | LITTLE ROCK
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State | AR
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Zip | 72223-3931
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Country | US
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Telephone | 501-960-5740
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State | AR
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