MEDICARE: KENDRA S GARDNER NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	902266	MS
2	363LF0000X	Family Nurse Practitioner	902266	MS

General Provider Information

NPI Number	:	1134628985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRA S GARDNER NP

Provider Business Mailing Address
First Line	:	4730 MORRIS ST
Second Line	:
City	:	MOSS POINT
State	:	MS
Zip	:	39563-2838
Country	:	US
Telephone Number	:	228-285-0361
Fax Number	:	228-285-0356

Provider Business Practice Location Address
First Line	:	4730 MORRIS ST
Second Line	:
City	:	MOSS POINT
State	:	MS
Zip	:	39563-2838
Country	:	US
Telephone Number	:	228-285-0361
Fax Number	:	228-285-0356

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2018
Last Update Date	:	02/11/2026

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