MEDICARE: JUDITH AWITI GORDON NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	AG07250052	TX

General Provider Information

NPI Number	:	1528948247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH AWITI GORDON NP

Provider Business Mailing Address
First Line	:	1907 SAIL FISH DR
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-5963
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1907 SAIL FISH DR
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-5963
Country	:	US
Telephone Number	:	469-980-0636
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2025
Last Update Date	:	03/09/2026

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