Individual
MRS. CARRIE GORDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1135 RED MILE PLACE, LEXINGTON, KY 40504
(859) 288-4053
(859) 288-4084
Mailing address
1135 RED MILE PLACE, LEXINGTON, KY 40504
(859) 288-4053
(859) 288-4084
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
2358-P
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
78002011
—
KY
Enumeration date
02/05/2007
Last updated
08/04/2009
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