# AMY LYNN GORDON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1407159411
- **Gender:** F
- **Credential:** PA

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 499 | OK | Yes |

## Other

- **Enumeration date:** 12/13/2010
- **Last updated:** 02/08/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200318240A | — | OK |
| 01 | — | 499 | STATE OF OKLAHOMA CLINICAL LICENSE | OK |