Kevin Darelle Gordon, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

95015623 Issued in CA

Practice address

10385 Old Placerville Rd
Sacramento, CA 95827-2506

Phone

(916) 448-1770

NPI assigned

Mar 2, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Kevin Darelle Gordon Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1614643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614643200000",
    "number": "1942895925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9554 TARBERT DR",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957584478",
            "telephone_number": "404-384-0439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10385 OLD PLACERVILLE RD",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958272506",
            "telephone_number": "916-448-1770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "KEVIN",
        "middle_name": "DARELLE",
        "name_prefix": "Mr.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-03-02",
        "last_updated": "2021-03-02",
        "certification_date": "2021-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95015623",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KEVIN",
            "last_name": "GORDON",
            "middle_name": "DARELLE",
            "credential": "NP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Brady Gordon, LCSW
• Brent Kobe Gordon, M.D.
• Bruce L. Gordon, MD
• Jody Gordon, M.D.
• Kaia Gordon
• Lashon Gordon
• Mikayla Gordon
• Nathaniel Gordon, MD
• Nishay Janel Gordon
• Rain Gordon, RBT

• Nurse Practitioner in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 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.