Provider Demographics
NPI:1801023718
Name:GORDON, KRISTYN LEE (APRN)
Entity Type:Individual
Prefix:
First Name:KRISTYN
Middle Name:LEE
Last Name:GORDON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:DEPARTMENT OF CT SURGERY, COX 6
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2621
Mailing Address - Country:US
Mailing Address - Phone:617-754-4410
Mailing Address - Fax:
Practice Address - Street 1:740 S LIMESTONE STE J301
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-2621
Practice Address - Country:US
Practice Address - Phone:859-323-1691
Practice Address - Fax:859-323-1700
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2023-02-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA213890363LA2200X
KY3007279363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health