| Doctor Name: | MR. THOMAS CHARLES GARDNER |
| NPI Number: | 1811153729 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | APN |
| License Number: | RN |
| Business Practice Address: | 2642 State Route 76 Willow Springs, MO - 657938254 |
| Business Phone Number: | 4174695124 |
| Business Fax Number: | 4174691165 |
| Mailing Address: | 2642 State Route 76, WILLOW SPRINGS |
| State: | MO |
| Postal Code: | 657938254 |
| Phone Number: | 4174695124 |
| Fax Number: | 4174691165 |
| NPI Enumeration Date: | 07/30/2008 |
| NPI Last Update Date: | 06/29/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | RN |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |