Stacy Gordon, REGISTERED NURSE

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

0001259955 Issued in VA

Practice address

3316 Montrose Ave
Alexandria, VA 22305-3032

Phone

(120) 259-0529

NPI assigned

Jan 11, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1704931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706140800000",
    "number": "1548031313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3316 MONTROSE AVE",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223053032",
            "telephone_number": "703-887-4420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3316 MONTROSE AVE",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223053032",
            "telephone_number": "120-259-0529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "STACY",
        "credential": "REGISTERED NURSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-11",
        "last_updated": "2024-01-25",
        "certification_date": "2024-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171400000X",
            "taxonomy_group": "",
            "desc": "Health & Wellness Coach",
            "state": "VA",
            "license": "0001259955",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "VA",
            "license": "0001259955",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen Frances Gordon-Granado, LPC
• Angela T Gordon, P.T.
• Ian David Gordon, MD
• Janea Gordon, OTR/L
• Meghan Gordon
• Teresa Gordon
• Vivek Gorijala, MD
• Ryan Gorman, PMHNP
• Colleen Alexandra Gorr, MS OTR/L
• Michele D Goss, PH.D.

• Registered Nurse in Alexandria, VA
• Providers in Alexandria, VA by specialty
• Registered Nurse in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 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.