Provider Demographics
NPI:1275194300
Name:GORDON, KALEIGH (APRN)
Entity Type:Individual
Prefix:
First Name:KALEIGH
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 DUNFRIES RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-4236
Mailing Address - Country:US
Mailing Address - Phone:256-295-1794
Mailing Address - Fax:
Practice Address - Street 1:3535 DUNFRIES RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-4236
Practice Address - Country:US
Practice Address - Phone:256-295-1794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-28
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11002935363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner