Provider Demographics
NPI:1548600612
Name:HARRINGTON, JORDAN (NP)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:HARRINGTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:H
Other - Last Name:WOOLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39649-0490
Mailing Address - Country:US
Mailing Address - Phone:601-249-1350
Mailing Address - Fax:
Practice Address - Street 1:303 MARION AVE.
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648
Practice Address - Country:US
Practice Address - Phone:601-249-1350
Practice Address - Fax:601-249-1339
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR882689363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03656204Medicaid
MS03656204Medicaid