Provider Demographics
NPI:1245045418
Name:JORDAN, G LYNNETTE
Entity type:Individual
Prefix:
First Name:G
Middle Name:LYNNETTE
Last Name:JORDAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16401 CHENAL VALLEY DR APT 3203
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-3931
Mailing Address - Country:US
Mailing Address - Phone:501-960-5740
Mailing Address - Fax:
Practice Address - Street 1:712 W 3RD ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72201-2220
Practice Address - Country:US
Practice Address - Phone:501-379-4246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-12
Last Update Date:2025-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist