Individual Healthcare Provider
Kimberly Renee Gordon, PA-C
Provider's NPPES record last updated: March 30, 2023
Overview
- Entity Type
- Individual Healthcare Provider
- NPI
- 1346562147
- Primary Specialty
- Physician Assistant
- Practice Location
- Waxhaw, North Carolina
- Sole Proprietor
- No
Federal Screening
NPISignal checked this NPI against federal exclusion sources. Results below are based on the NPI number itself — an identifier match, not a name match.
List of Excluded Individuals/Entities (LEIE)
HHS Office of Inspector General
No potential match was identified in NPISignal's indexed List of Excluded Individuals/Entities (LEIE) records as of 2026-09-10.
- Source data
- September 10, 2026
- Records indexed
- 84,001
- Screened
- Sep 21, 2026, 3:46 AM UTC
This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.
SAM.gov Exclusions
U.S. General Services Administration
SAM.gov Exclusions was not checked.
SAM.gov screening is not configured on this deployment. No SAM check has been performed.
- Screened
- Not checked
This is an NPI-based check only. NPISignal does not publish name-based exclusion matches on a provider profile. A shared or similar name is a lead that requires human review, not an identification, and this page is not the place to make one. Run a name-based screening below to see potential matches with the reasons for each.
This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.
Searches OIG LEIE and SAM.gov by name and reviews every potential match.
Specialties & Taxonomies
- Primary
Physician Assistant
Physician Assistants & Advanced Practice Nursing Providers
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
Taxonomy code 363A00000X Physician Assistant
Medical
Physician Assistants & Advanced Practice Nursing Providers
Definition to come...
Taxonomy code 363AM0700X
Provider-Reported License Information
- Physician Assistant (North Carolina)
- 0010-07737
- Physician Assistant (Florida)
- PA9105103
Practice Locations
Practice Location
9929 Rea Rd Ste 201
Waxhaw, North Carolina 28173-6439
Phone: (704) 316-1650
Additional Practice Location
3131 N Mcmullen Booth Rd
Clearwater, Florida 33761-2008
Phone: (727) 726-8871
Fax: (727) 726-8571
Additional Practice Location
9623 Redstone Dr Ste 300
Indian Land, South Carolina 29707
Phone: (803) 615-0880
Additional Practice Location
1401 Matthews Township Pkwy Ste 320
Matthews, North Carolina 28105-5403
Phone: (704) 384-1261
Record Information
- Enumeration Date
- February 20, 2010
- Provider's NPPES Record Last Updated
- March 30, 2023
- Certification Date
- March 30, 2023
- NPISignal NPPES Dataset
- August 2026
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