Anne Marie Lackey Gordon, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-12193 Issued in NC

Practice address

709 N Dekalb St
Shelby, NC 28150-3911

Phone

(980) 487-2100

NPI assigned

May 3, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: agordon1070163@carolinashealthcaresystem.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Carolinas Physicians Network, Inc

  • Family Medicine Physician
  • Charlotte, NC
  • NPI 1578939914
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1556841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1003471103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 N DEKALB ST",
            "city": "SHELBY",
            "state": "NC",
            "postal_code": "281503911",
            "telephone_number": "980-487-2100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2202 Carolina Pl",
            "address_2": "Ste 200",
            "address_purpose": "LOCATION",
            "city": "Kings Mountain",
            "state": "NC",
            "postal_code": "280868807",
            "country_code": "US",
            "telephone_number": "980-487-2950",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GORDON",
        "first_name": "ANNE",
        "middle_name": "MARIE LACKEY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-03",
        "last_updated": "2024-07-15",
        "certification_date": "2022-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-12193",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "agordon1070163@CarolinasHealthcareSystem.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "709 N Dekalb St",
            "city": "Shelby",
            "state": "NC",
            "country_code": "US",
            "postal_code": "281503911",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "ABILITY Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Benjamin Goldman, M.D.
• Melissa Ann Goldstein, PA
• Kimberly Tweedy Goodman, NP
• Joanie Michele Goodson
• Matthew Troy Goodwin, PA-C
• Shannon Suzette Gordon
• Robert Peter Gossett, M.D.
• Mary Gragg
• Casey Grant, PHARMD
• Ma'Lee Gray

• Physician Assistant in Shelby, NC
• Providers in Shelby, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.