Provider Demographics
NPI:1609411123
Name:GOSSETT, JORDAN
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:GOSSETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7033 FM 765
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE
Mailing Address - State:TX
Mailing Address - Zip Code:76872-4210
Mailing Address - Country:US
Mailing Address - Phone:325-792-4152
Mailing Address - Fax:
Practice Address - Street 1:1333 W WAHINGTON ST
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76402-0001
Practice Address - Country:US
Practice Address - Phone:325-792-4152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program