Healthcare Provider Details

I. General information

NPI: 1154235554
Provider Name (Legal Business Name): ALISON GORDON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CASTLE DR
GEORGETOWN KY
40324-9473
US

IV. Provider business mailing address

201 CASTLE DR
GEORGETOWN KY
40324-9473
US

V. Phone/Fax

Practice location:
  • Phone: 646-750-0224
  • Fax: 646-750-0224
Mailing address:
  • Phone: 646-750-0224
  • Fax: 646-750-0224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number237736
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: