| Doctor Name: | SAMANTHA GARDNER |
| NPI Number: | 1053772954 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CPNP-PC |
| License Number: | 109994 |
| Business Practice Address: | 513 Hillery Rd Suite C Comanche, OK - 735291200 |
| Business Phone Number: | 5804392000 |
| Business Fax Number: | 5804395669 |
| Mailing Address: | 513 Hillery Rd, Suite C COMANCHE |
| State: | OK |
| Postal Code: | 735291200 |
| Phone Number: | 5804392000 |
| Fax Number: | 5804395669 |
| NPI Enumeration Date: | 03/19/2016 |
| NPI Last Update Date: | 03/19/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | 109994 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |