Provider Demographics
NPI:1861256307
Name:WHITE, JORDAN B
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:B
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4820 NORTHAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-5730
Mailing Address - Country:US
Mailing Address - Phone:601-616-1710
Mailing Address - Fax:
Practice Address - Street 1:4820 NORTHAMPTON DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-5730
Practice Address - Country:US
Practice Address - Phone:601-616-1710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program