Provider Demographics
NPI:1265884944
Name:SMART, JORDAN ASHLEY
Entity type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:ASHLEY
Last Name:SMART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:ASHLEY
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9842 AUDELIA RD APT 1100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-1967
Mailing Address - Country:US
Mailing Address - Phone:501-520-8670
Mailing Address - Fax:
Practice Address - Street 1:9842 AUDELIA RD APT 1100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-1967
Practice Address - Country:US
Practice Address - Phone:501-520-8670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other