Individual provider · Type 1 NPI
Kendra Marie Gordon
Primary Care Nurse Practitioner · Charleston, SC
NPI number
1104712801
Active
Practice location
171 Ashley Ave
Charleston, SC 29425-8900
Mailing address
PO Box 751461
Charlotte, NC 28275-1461
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Primary Care Nurse Practitioner Primary | 363LP2300X | 30532 (SC) |
Primary Care Nurse Practitioner: Definition to come...
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About NPI 1104712801
Kendra Marie Gordon's National Provider Identifier is 1104712801, issued on Jun 17, 2025. The primary taxonomy on file is Primary Care Nurse Practitioner (363LP2300X), and the practice location is in Charleston, SC. The record was last updated on Jul 12, 2025.