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General NPI Number Information
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NPI Number | 1194349019
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Entity Type | Individual
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Provider Name | KELLY MARIE GORDON APRN
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Gender | Female
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Dates
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Enumeration Date | 06/05/2020
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 13462 TAFT ST
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City | BROOKSVILLE
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State | FL
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Zip | 34613-6820
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Country | US
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Telephone | 352-600-8822
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Fax | 352-600-8883
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Provider Business Mailing Address
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Address Line | 10220 YALE AVE
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City | WEEKI WACHEE
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State | FL
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Zip | 34613-8375
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Country | US
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Telephone | 352-600-8822
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Fax | 352-600-8883
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11007511
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 11007511
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | C-RXN.0103332-C-NP
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License Number State | CO
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