Provider Demographics
NPI:1821650045
Name:JORDAN, CHARLOTTE DENISE (MSN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:DENISE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:MRS
Other - First Name:CHARLOTTE
Other - Middle Name:DENISE
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-C
Mailing Address - Street 1:117 S 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-4312
Mailing Address - Country:US
Mailing Address - Phone:601-425-3033
Mailing Address - Fax:
Practice Address - Street 1:6051 U S HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401
Practice Address - Country:US
Practice Address - Phone:601-450-0310
Practice Address - Fax:601-450-0321
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR870743363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily