Provider Demographics
NPI:1154173482
Name:GORDON, KATHRYN (NP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3671 SOUTHWESTERN BLVD
Mailing Address - Street 2:101
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127
Mailing Address - Country:US
Mailing Address - Phone:716-662-7008
Mailing Address - Fax:716-662-5226
Practice Address - Street 1:3671 SOUTHWESTERN BLVD
Practice Address - Street 2:101
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127
Practice Address - Country:US
Practice Address - Phone:716-662-7008
Practice Address - Fax:716-662-5226
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF311699-01363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner