Doctor Name: | AMY D. GARDNER |
NPI Number: | 1639248131 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-C |
License Number: | 134830 |
Business Practice Address: | 102 Courtney Lane Crane, MO - 656339192 |
Business Phone Number: | 4172692264 |
Business Fax Number: | 4172692270 |
Mailing Address: | 3800 S. National Ave, #540 SPRINGFIELD |
State: | MO |
Postal Code: | 658075284 |
Phone Number: | 4172692264 |
Fax Number: | 4172692270 |
NPI Enumeration Date: | 11/07/2006 |
NPI Last Update Date: | 12/04/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 134830 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |