Individual
RITA L GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
3502 W NORTHSIDE DR, JACKSON, MS 39213-4454
(601) 362-5321
Mailing address
3502 W NORTHSIDE DR, JACKSON, MS 39213-4454
(601) 362-5321
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R784456
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R784456
MS LICENSE
MS
Enumeration date
08/17/2006
Last updated
07/12/2011
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