Tara Rae Gordijenko

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

LP55602 Issued in MD

Practice address

210 Isaac Dr
Bunker Hill, WV 25413-4267

Phone

(681) 273-9995

Fax

(681) 227-9995

NPI assigned

Jul 31, 2026

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1785456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785456000000",
    "number": "1104749837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 ISAAC DR",
            "city": "BUNKER HILL",
            "state": "WV",
            "postal_code": "254134267",
            "telephone_number": "681-273-9995",
            "fax_number": "681-227-9995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 ISAAC DR",
            "city": "BUNKER HILL",
            "state": "WV",
            "postal_code": "254134267",
            "telephone_number": "681-273-9995",
            "fax_number": "681-227-9995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDIJENKO",
        "first_name": "TARA",
        "middle_name": "RAE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-07-31",
        "last_updated": "2026-07-31",
        "certification_date": "2026-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Licensed Practical Nurse",
            "state": "MD",
            "license": "LP55602",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Licensed Practical Nurse in Bunker Hill, WV
• Providers in Bunker Hill, WV by specialty
• Licensed Practical Nurse in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2026; 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.