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General NPI Number Information
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NPI Number | 1710711262
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Entity Type | Individual
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Provider Name | CAROLYN JACKMAN GORDON CRNP, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/28/2024
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 401 W 27TH ST
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City | LUMBERTON
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State | NC
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Zip | 28358-3019
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Country | US
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Telephone | 910-370-0434
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Fax |
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Provider Business Mailing Address
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Address Line | 34 SHINING WILLOW WAY # 239
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City | LA PLATA
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State | MD
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Zip | 20646-4224
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Country | US
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Telephone | 304-542-6475
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Fax | 240-690-6614
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AC006921
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License Number State | MD
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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 | 5022591
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License Number State | NC
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