MEDICARE: MICAELA N GORDON FNP

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	363LF0000X	Family Nurse Practitioner	AP144351	TX
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP144351	TX

General Provider Information

NPI Number	:	1598303364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICAELA N GORDON FNP

Provider Business Mailing Address
First Line	:	4202 BERRY COVE CIR
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-7216
Country	:	US
Telephone Number	:	346-232-9453
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 MAIN ST STE 102
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-3230
Country	:	US
Telephone Number	:	346-232-9453
Fax Number	:

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

Provider Enumeration Date	:	12/12/2019
Last Update Date	:	03/10/2026

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Directions to “ MICAELA N GORDON FNP” Practice Location

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