Individual
JO R GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, BC
Contact information
Practice address
421 SE MAIN ST # UT100, SIMPSONVILLE, SC 29681-2695
(864) 963-0045
Mailing address
421 SE MAIN ST # UT100, SIMPSONVILLE, SC 29681-2695
(864) 963-0045
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
5007192
NC
363LF0000X
Family Nurse Practitioner
Primary
2662
SC
363LF0000X
Family Nurse Practitioner
5007192
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1609801505
—
NC
01
—
1892F
BCBS NC
NC
05
—
NP1097
—
SC
Enumeration date
07/11/2006
Last updated
05/06/2021
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