=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306440003
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JORDAN MARIE MCCLONEY NP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/24/2020
-----------------------------------------------------
Last Update Date | 03/17/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 410 ANDREWS LN
-----------------------------------------------------
City | SAVANNAH
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38372-5754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-313-3986
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 302 NE 14TH ST
-----------------------------------------------------
City | LEON
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50144-1206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 641-446-2383
-----------------------------------------------------
Fax | 641-446-2382
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 28452
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------