Gordon, Kenyetta Michelle

Gordon, Kenyetta Michelle is an individual health care provider with primary practice located at 1675 Northcrest Dr , Crescent City CA 95531-8928. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Gordon, Kenyetta Michelle can be contacted via phone (707) 464-2750.

Contact Information

Primary practice address
1675 Northcrest Dr Crescent City CA 95531-8928
Phone: (707) 464-2750
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 19863 Nevada
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X E-6423 Arkansas
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X C186176 California

Profile Details

NPI number 1013101161
LBN Legal business name Gordon, Kenyetta Michelle
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 31st, 2007
Last updated May 26th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1013101161 NPPES
Nevada MEDICAID 1013101161

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