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General NPI Number Information
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NPI Number | 1710633110
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Entity Type | Individual
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Provider Name | LESLIE GORDON FNP
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Gender | Female
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Dates
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Enumeration Date | 02/23/2022
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Last Update Date | 02/23/2022
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Provider Practice Location Address
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Address Line | 2680 W OXFORD LOOP
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City | OXFORD
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State | MS
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Zip | 38655-5441
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Country | US
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Telephone | 662-236-6465
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Fax |
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Provider Business Mailing Address
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Address Line | 27 COUNTY ROAD 376
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City | WATER VALLEY
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State | MS
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Zip | 38965-3748
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Country | US
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Telephone | 662-931-7653
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | GORD-FDW4W3
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License Number State | MS
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