Provider Demographics
NPI:1952929713
Name:JONES GORDON, KIMBERLIE BERNICE
Entity type:Individual
Prefix:
First Name:KIMBERLIE
Middle Name:BERNICE
Last Name:JONES GORDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 COURT ST STE B
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-5004
Mailing Address - Country:US
Mailing Address - Phone:727-295-1000
Mailing Address - Fax:
Practice Address - Street 1:1212 COURT ST STE B
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-5004
Practice Address - Country:US
Practice Address - Phone:727-295-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist