Provider Demographics
NPI:1023631736
Name:GORDON, GWEN (MSN, APRN,FNP-C)
Entity type:Individual
Prefix:MRS
First Name:GWEN
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:MSN, APRN,FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10490 SHELBYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-3120
Mailing Address - Country:US
Mailing Address - Phone:502-245-8853
Mailing Address - Fax:
Practice Address - Street 1:10490 SHELBYVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-3120
Practice Address - Country:US
Practice Address - Phone:502-245-8853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014058363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily