Individual
MRS. BRENDA KAY GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
340 KELLEY PKWY, MEXICO, MO 65265-3811
(573) 582-1234
(573) 582-1212
Mailing address
340 KELLEY PKWY, MEXICO, MO 65265-3811
(573) 582-1234
(573) 582-1212
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
209012239
IL
363LF0000X
Family Nurse Practitioner
Primary
2014035652
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1497149652
—
MO
Enumeration date
03/26/2015
Last updated
01/18/2024
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