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General NPI Number Information
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NPI Number | 1306932033
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Entity Type | Individual
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Provider Name | MARTI LIANNE JORDAN PHD, NP
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Gender | Female
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 10/14/2020
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Provider Practice Location Address
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Address Line | 6051 U S HIGHWAY 49
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City | HATTIESBURG
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State | MS
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Zip | 39401-7200
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Country | US
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Telephone | 601-288-1212
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Fax |
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Provider Business Mailing Address
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Address Line | 3019 MAGNOLIA PL
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City | HATTIESBURG
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State | MS
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Zip | 39402-2431
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Country | US
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Telephone | 601-264-0696
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 212322
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R855681
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 212322
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License Number State | LA
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