Doctor Name: | JENNIE GARDNER |
NPI Number: | 1790869071 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APRN |
License Number: | 3003792 |
Business Practice Address: | 784 Highway 36 Frenchburg, KY - 403228123 |
Business Phone Number: | 6067689190 |
Business Fax Number: | 6067689180 |
Mailing Address: | 784 Highway 36, FRENCHBURG |
State: | KY |
Postal Code: | 403228123 |
Phone Number: | 6067689190 |
Fax Number: | 6067689180 |
NPI Enumeration Date: | 10/24/2006 |
NPI Last Update Date: | 09/29/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 3003792 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |