Provider Demographics
NPI:1962974022
Name:KIRKLAND, JORDAN COLBY (CRNA)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:COLBY
Last Name:KIRKLAND
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11071D HIGHWAY 188
Mailing Address - Street 2:
Mailing Address - City:GRAND BAY
Mailing Address - State:AL
Mailing Address - Zip Code:36541-6219
Mailing Address - Country:US
Mailing Address - Phone:251-802-5926
Mailing Address - Fax:
Practice Address - Street 1:2809 DENNY AVE
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-5301
Practice Address - Country:US
Practice Address - Phone:228-809-5540
Practice Address - Fax:228-809-1153
Is Sole Proprietor?:No
Enumeration Date:2018-12-28
Last Update Date:2022-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-148131367500000X
MS901785367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered