Provider Demographics
NPI:1053813303
Name:GORDON, ALLIE (APRN)
Entity Type:Individual
Prefix:
First Name:ALLIE
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ALLIE
Other - Middle Name:
Other - Last Name:GEARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6749
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-0749
Mailing Address - Country:US
Mailing Address - Phone:502-899-7646
Mailing Address - Fax:502-895-8977
Practice Address - Street 1:4000 KRESGE WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4605
Practice Address - Country:US
Practice Address - Phone:502-899-7646
Practice Address - Fax:502-899-7648
Is Sole Proprietor?:No
Enumeration Date:2018-03-02
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012029363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner