Basic Information
| Provider Information | |||||||||
| NPI: | 1306227434 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JORDAN | ||||||||
| FirstName: | CHRIS | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 STONE CREEK BLVD. | ||||||||
| Address2: | STE 500 | ||||||||
| City: | FLOWOOD | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392328210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7692352941 | ||||||||
| FaxNumber: | 6019392211 | ||||||||
| Practice Location | |||||||||
| Address1: | 2815 LONGVIEW DR | ||||||||
| Address2: | |||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724015919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702754024 | ||||||||
| FaxNumber: | 8555404722 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2015 | ||||||||
| LastUpdateDate: | 05/16/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | A004409 | AR | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 363LF0000X | A004409 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.