Provider Demographics
NPI:1215592647
Name:TRIMM, JORDAN LEIGH
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:LEIGH
Last Name:TRIMM
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 1:12 SERENE CV
Mailing Address - Street 2:
Mailing Address - City:PETAL
Mailing Address - State:MS
Mailing Address - Zip Code:39465-3945
Mailing Address - Country:US
Mailing Address - Phone:601-447-7234
Mailing Address - Fax:
Practice Address - Street 1:12 SERENE CV
Practice Address - Street 2:
Practice Address - City:PETAL
Practice Address - State:MS
Practice Address - Zip Code:39465-3945
Practice Address - Country:US
Practice Address - Phone:601-447-7234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program