Healthcare Provider Details

I. General information

NPI: 1811845456
Provider Name (Legal Business Name): WHITNEY NICOLE GORDON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 S WASHINGTON ST STE 200
CLINTON KY
42031-1347
US

IV. Provider business mailing address

PO BOX 497
AUGUSTA AR
72006-0497
US

V. Phone/Fax

Practice location:
  • Phone: 270-913-2478
  • Fax: 270-913-2479
Mailing address:
  • Phone: 870-347-2534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4054276
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: