Healthcare Provider Details

I. General information

NPI: 1891699286
Provider Name (Legal Business Name): REBECCA LYNN GORDON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335588 E 750 RD
PERKINS OK
74059-3268
US

IV. Provider business mailing address

6885 OAK FORREST CIR
STILLWATER OK
74074-6181
US

V. Phone/Fax

Practice location:
  • Phone: 405-547-2473
  • Fax:
Mailing address:
  • Phone: 405-614-0003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number210749
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: