Gordon, Jo R

Gordon, Jo R is an individual health care provider with primary practice located at 421 Se Main St # Ut100 , Simpsonville SC 29681-2695. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Gordon, Jo R can be contacted via phone (864) 963-0045.

Contact Information

Primary practice address
421 Se Main St # Ut100 Simpsonville SC 29681-2695
Phone: (864) 963-0045
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 5007192 North Carolina
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 5007192 North Carolina
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 2662 South Carolina

Profile Details

NPI number 1609801505
LBN Legal business name Gordon, Jo R
Credentials APRN, BC
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 11th, 2006
Last updated May 6th, 2021 - about 5 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 1609801505 NPPES
North Carolina Other 1892F BCBS NC
North Carolina MEDICAID 1609801505 BCBS NC
North Carolina MEDICAID NP1097 BCBS NC

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