Gordon, Kimberly Renee

Gordon, Kimberly Renee is an individual health care provider with primary practice located at 9929 Rea Rd Ste 201 , Waxhaw NC 28173-6439. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Medical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is her primary health care specialty. Gordon, Kimberly Renee can be contacted via phone (704) 316-1650.

Contact Information

Primary practice address
9929 Rea Rd Ste 201 Waxhaw NC 28173-6439
Phone: (704) 316-1650
Fax: (704) 316-1651
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA9105103 Florida
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 0010-07737 North Carolina

Profile Details

NPI number 1346562147
LBN Legal business name Gordon, Kimberly Renee
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 20th, 2010
Last updated Mar 30th, 2023 - 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 1346562147 NPPES
Florida MEDICAID 018579700
Florida Other Y0S1D

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