Carolyn Jackman Gordon, CRNP, PMHNP-BC in La Plata, MD

Carolyn Jackman Gordon, CRNP, PMHNP-BC is a medicare enrolled "Nurse Practitioner - Psychiatric/mental Health" in La Plata, Maryland. Her current practice location is 34 Shining Willow Way # 239, La Plata, Maryland. You can reach out to her office (for appointments etc.) via phone at (015) 426-4753.

Carolyn Jackman Gordon is licensed to practice in Maryland (license number AC006921) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1710711262.

Contact Information

	Carolyn Jackman Gordon, CRNP, PMHNP-BC
	34 Shining Willow Way # 239, La Plata, MD 20646-4224
	(015) 426-4753
	(240) 690-6614

Map and Direction

Provider's Profile

Full Name	Carolyn Jackman Gordon
Gender	Female
Speciality	Nurse Practitioner - Psychiatric/mental Health
Location	34 Shining Willow Way # 239, La Plata, Maryland
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1710711262
Provider Enumeration Date: 08/28/2024
Last Update Date: 05/21/2025

Medicare PECOS Information:

PECOS PAC ID: 0547797706
Enrollment ID: I20241230001258

Medical Identifiers

Medical identifiers for Carolyn Jackman Gordon such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1710711262	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LP0808X	Nurse Practitioner - Psychiatric/mental Health	AC006921 (Maryland)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Carolyn Jackman Gordon allows following entities to bill medicare on her behalf.

Entity Name	Mem Scepter Home & Behavioral
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1407462559 PECOS PAC ID: 1355753765 Enrollment ID: O20201209000068

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Carolyn Jackman Gordon is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Carolyn Jackman Gordon, CRNP, PMHNP-BC 34 Shining Willow Way # 239, La Plata, MD 20646-4224 Ph: (304) 542-6475	Carolyn Jackman Gordon, CRNP, PMHNP-BC 34 Shining Willow Way # 239, La Plata, MD 20646-4224 Ph: (015) 426-4753

Reviews and Comments

Nurse Practitioner Nurses in La Plata, MD

Mrs. Natasha Chinakesha Decaires-chester, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 5 Garrett Ave, La Plata, MD 20646 Phone: 301-609-4287
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Gretchen Ann Machesney, ACNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 5 Garrett Ave, La Plata, MD 20646 Phone: 301-609-4000
Elizabeth Anne Fifelski, MSN, FNP-BC Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 16 N La Plata Ct, La Plata, MD 20646 Phone: 732-850-2252
Jessica Lorraine Milton, CRNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 115a La Grange Ave # A, La Plata, MD 20646 Phone: 301-392-1935
Dr. Paul Michael Patterson, D.N.P. Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 115a La Grange Ave, Suite 101, La Plata, MD 20646 Phone: 301-392-1935 Fax: 301-392-1936

Carolyn Jackman Gordon, CRNP, PMHNP-BC - Medicare Nurse Practitioner in La Plata, MD