Provider Demographics
NPI:1336793611
Name:FLETCHER, JORDAN BROOKE (APRN)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:BROOKE
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1960
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-1960
Mailing Address - Country:US
Mailing Address - Phone:870-936-8000
Mailing Address - Fax:870-934-3666
Practice Address - Street 1:516 INDUSTRIAL PARK DR
Practice Address - Street 2:
Practice Address - City:TRUMANN
Practice Address - State:AR
Practice Address - Zip Code:72472-9602
Practice Address - Country:US
Practice Address - Phone:870-936-8000
Practice Address - Fax:870-934-3666
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR121621363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care