Jo R Gordon, APRN, BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

2662 Issued in SC

Practice address

421 SE Main St # Ut100
Simpsonville, SC 29681-2695

Phone

(864) 963-0045

NPI assigned

Jul 11, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 1

• Ms. Jo R Bradley Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• Lutheran Homes of SC, Inc.

  • Community Based Hospice Care Agency
  • Chapin, SC
  • NPI 1275531758
  NPD (past)

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620259200000",
    "number": "1609801505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 SE MAIN ST # UT100",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "296812695",
            "telephone_number": "864-963-0045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 SE MAIN ST # UT100",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "296812695",
            "telephone_number": "864-963-0045"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "90 Southside Ave",
            "address_2": "Suite 350",
            "address_purpose": "LOCATION",
            "city": "Asheville",
            "state": "NC",
            "postal_code": "288014160",
            "country_code": "US",
            "telephone_number": "828-277-4810",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GORDON",
        "first_name": "JO",
        "middle_name": "R",
        "credential": "APRN, BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-11",
        "last_updated": "2021-05-06",
        "certification_date": "2021-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5007192",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5007192",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "2662",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NC",
            "identifier": "1892F",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1609801505",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP1097",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JO",
            "last_name": "BRADLEY",
            "middle_name": "R",
            "prefix": "MS.",
            "credential": "FNP, MS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Emely Gomez
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• Judy Goodwin
• Malcolm N. Goodwin III, PHARMD
• Zaina Gordon
• Grace Internal Medicine LLC
• Sheila Graham
• Silvia Ann Graves-Owens, PH.D.
• Greater Greenville Chiropractic, LLC

• Family Nurse Practitioner in Simpsonville, SC
• Providers in Simpsonville, SC by specialty
• Family Nurse Practitioner in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2021; 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.