Healthcare Provider Details

I. General information

NPI: 1760307698
Provider Name (Legal Business Name): DEBORAH GORDON LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 DENISON ST
CONWAY AR
72034-6127
US

IV. Provider business mailing address

8 E ROCKWOOD DR
CONWAY AR
72034-2905
US

V. Phone/Fax

Practice location:
  • Phone: 501-327-1325
  • Fax: 501-327-1328
Mailing address:
  • Phone: 501-327-1325
  • Fax: 501-327-1328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL049838
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: