Provider Demographics
NPI:1689471518
Name:GORDON, KOURTNEY (MS,RD/LD,CEDRD)
Entity type:Individual
Prefix:
First Name:KOURTNEY
Middle Name:
Last Name:GORDON
Suffix:
Gender:
Credentials:MS,RD/LD,CEDRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3314 HENDERSON BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2934
Mailing Address - Country:US
Mailing Address - Phone:813-906-7707
Mailing Address - Fax:813-502-0266
Practice Address - Street 1:3314 HENDERSON BLVD STE 206
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2934
Practice Address - Country:US
Practice Address - Phone:813-906-7707
Practice Address - Fax:813-502-0266
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty