Healthcare Provider Details

I. General information

NPI: 1568669489
Provider Name (Legal Business Name): DEBORAH KIM GARDNER APRN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH KIM GARDNER APRN, FNP

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4951 S WHITE MOUNTAIN RD BLDG A
SHOW LOW AZ
85901-7827
US

IV. Provider business mailing address

4951 S WHITE MOUNTAIN RD BLDG A
SHOW LOW AZ
85901-7827
US

V. Phone/Fax

Practice location:
  • Phone: 928-537-6700
  • Fax: 928-532-2147
Mailing address:
  • Phone: 928-537-6700
  • Fax: 928-532-2147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1086
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number286441
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number576
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: