Individual
CAROLYN JACKMAN GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNP, PMHNP-BC
Contact information
Practice address
401 W 27TH ST, LUMBERTON, NC 28358-3019
(910) 370-0434
Mailing address
34 SHINING WILLOW WAY # 239, LA PLATA, MD 20646-4224
(304) 542-6475
(240) 690-6614
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
5022591
NC
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
AC006921
MD
Other
Enumeration date
08/28/2024
Last updated
05/04/2026
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