Provider Demographics
NPI:1134121866
Name:GORDON, JAMES MORRIS (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MORRIS
Last Name:GORDON
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 HARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-7642
Mailing Address - Country:US
Mailing Address - Phone:903-780-5871
Mailing Address - Fax:903-535-6884
Practice Address - Street 1:1000 S. BECHAM
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701
Practice Address - Country:US
Practice Address - Phone:903-590-5611
Practice Address - Fax:903-535-6884
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX443136363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXGPZ000089K4Medicaid
TX443136OtherRN/FNP STATE LICENSE
LARN036648 APO4171OtherNP LICENSE
89662JMedicare ID - Type Unspecified
TXGPZ000089K4Medicaid