Individual
MR. KEVIN DARELLE GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
10385 OLD PLACERVILLE RD, SACRAMENTO, CA 95827-2506
(916) 448-1770
Mailing address
9554 TARBERT DR, ELK GROVE, CA 95758-4478
(404) 384-0439
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
95015623
CA
Other
Enumeration date
03/02/2021
Last updated
03/02/2021
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