Individual
KATE K. GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
111 S GRANT AVE STE 350, COLUMBUS, OH 43215-4701
(614) 566-9160
Mailing address
5450 FRANTZ RD STE 360, DUBLIN, OH 43016-4141
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.004209RX
OH
363AM0700X
Medical Physician Assistant
—
IN
363AS0400X
Surgical Physician Assistant
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000758875
BCBS
IN
01
—
000000776309
BCBS
IN
Enumeration date
08/30/2011
Last updated
01/03/2023
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