Active NPI
Kelly Lynn Gordon, SLP
- Speech-Language Pathologist
- Durham, NC
National Provider Identifier
1063541829
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 6510
- Practice address
- 40 Duke Medicine Cir
Clinic 1I
Durham, NC 27710-4000 - Phone
- (919) 684-3451
- NPI assigned
- Mar 5, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 6510 | NC | Primary |
Addresses
Primary practice location
40 Duke Medicine Cir
Clinic 1I
Durham, NC 27710-4000
Mailing address
PO Box 3887
BLDG. # 600
Durham, NC 27710-0001
Phone (919) 684-6271
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1443P | Other | NC | BLUE CROSS |
| 7412614 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6510 | NC | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1429228800000",
"number": "1063541829",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3887",
"address_2": "BLDG. # 600",
"city": "DURHAM",
"state": "NC",
"postal_code": "277100001",
"telephone_number": "919-684-6271"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "40 DUKE MEDICINE CIR",
"address_2": "CLINIC 1I",
"city": "DURHAM",
"state": "NC",
"postal_code": "277104000",
"telephone_number": "919-684-3451"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "KELLY",
"middle_name": "LYNN",
"name_prefix": "Mrs.",
"credential": "SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-05",
"last_updated": "2015-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NC",
"license": "6510",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "1443P",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7412614",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Durham, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.