Healthcare Provider Details

I. General information

NPI: 1891630489
Provider Name (Legal Business Name): ANGELA THERESA GORDON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 PARKWAY CIR # 550
SPRINGDALE AR
72762-6362
US

IV. Provider business mailing address

7522 DEVONSHIRE AVE
SPRINGDALE AR
72762-7016
US

V. Phone/Fax

Practice location:
  • Phone: 479-346-1850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number236894
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: