Individual
MICHAEL D GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
373 BREEZEEL SCHOOL RD, BENTON, KY 42025-5376
(307) 247-3661
Mailing address
373 BREEZEEL SCHOOL RD, BENTON, KY 42025-5376
(270) 703-7320
Taxonomy
Speciality
Code
Description
License number
State
364SA2200X
Adult Health Clinical Nurse Specialist
Primary
3011246
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100515830
—
KY
Enumeration date
04/12/2017
Last updated
10/21/2021
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