Provider Demographics
NPI:1497715437
Name:GORDON, CATHERINE A (NP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:A
Last Name:GORDON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 BRADSHAW
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66216
Mailing Address - Country:US
Mailing Address - Phone:913-735-4888
Mailing Address - Fax:913-825-6953
Practice Address - Street 1:9209 W. 110TH STREET
Practice Address - Street 2:BUILDING #36
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210
Practice Address - Country:US
Practice Address - Phone:913-735-4888
Practice Address - Fax:913-825-6953
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44791363LF0000X, 207V00000X
KS64072367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100447440GOtherHEALTHWAVE
KS100447440GOtherHEALTHWAVE
KST16A094Medicare ID - Type Unspecified