Provider Demographics
NPI:1942824008
Name:CLANTON, JORDAN JOSHUA
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:JOSHUA
Last Name:CLANTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:JOSHUA
Other - Last Name:CLANTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3030 LEADERSHIP PKWY UNIT 5310
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-2099
Mailing Address - Country:US
Mailing Address - Phone:702-809-5958
Mailing Address - Fax:
Practice Address - Street 1:502 SILVERSMITH PL
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-8148
Practice Address - Country:US
Practice Address - Phone:775-720-0004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16045830783747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty