Provider Demographics
NPI:1952134595
Name:GORDON, LINDSIE EARLINE
Entity type:Individual
Prefix:
First Name:LINDSIE
Middle Name:EARLINE
Last Name:GORDON
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 1:7104 MELROSE LN
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66203-4432
Mailing Address - Country:US
Mailing Address - Phone:913-406-0093
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 14368
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66285-4368
Practice Address - Country:US
Practice Address - Phone:913-302-7183
Practice Address - Fax:888-779-3217
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5383502071363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health