Healthcare Provider Details

I. General information

NPI: 1215553938
Provider Name (Legal Business Name): LIA KAY GORDON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2020
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N ROSEMONT BLVD
TUCSON AZ
85712-2139
US

IV. Provider business mailing address

PO BOX 81064
CLEVELAND OH
44181-0064
US

V. Phone/Fax

Practice location:
  • Phone: 520-881-1977
  • Fax: 520-881-1979
Mailing address:
  • Phone: 520-795-8080
  • Fax: 520-323-6237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95017142
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number242014
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: