Provider Demographics
NPI:1891312948
Name:GORDON, COURTNEY RAE (NP)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:RAE
Last Name:GORDON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:RAE
Other - Last Name:HOUSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7048 OLD CANTON RD STE 2E
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-1021
Mailing Address - Country:US
Mailing Address - Phone:601-992-9790
Mailing Address - Fax:601-992-9796
Practice Address - Street 1:410 ORCHARD PARK
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-5135
Practice Address - Country:US
Practice Address - Phone:601-957-0727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-05
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903982363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner