Gordon, Michael D

Gordon, Michael D is an sole proprietor health care provider with primary practice located at 373 Breezeel School Rd , Benton KY 42025-5376. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Adult Health, which is considered as his primary health care specialty. Gordon, Michael D can be contacted via phone (307) 247-3661.

Contact Information

Primary practice address
373 Breezeel School Rd Benton KY 42025-5376
Phone: (307) 247-3661
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 364SA2200X 3011246 Kentucky

Profile Details

NPI number 1225562622
LBN Legal business name Gordon, Michael D
Credentials Advanced Practice Registered Nurse (APRN)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 12th, 2017
Last updated Oct 21st, 2021 - about 3 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 1225562622 NPPES
Kentucky MEDICAID 7100515830

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