Provider Demographics
NPI:1063925519
Name:GUESS, MARANDA JORDAN (CPNP)
Entity type:Individual
Prefix:
First Name:MARANDA
Middle Name:JORDAN
Last Name:GUESS
Suffix:
Gender:
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:394 MALLALIEU DR SE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601-8786
Mailing Address - Country:US
Mailing Address - Phone:601-754-7905
Mailing Address - Fax:
Practice Address - Street 1:301C HIGHWAY 51 S
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-3247
Practice Address - Country:US
Practice Address - Phone:601-835-1062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-07
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902353363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics