Healthcare Provider Details

I. General information

NPI: 1467982447
Provider Name (Legal Business Name): TARRYN ANN GARDNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20805 W 151ST ST STE 200
OLATHE KS
66061-7249
US

IV. Provider business mailing address

22632 ST FRANCIS CT
SPRING HILL KS
66083-7900
US

V. Phone/Fax

Practice location:
  • Phone: 913-324-8571
  • Fax: 913-324-8590
Mailing address:
  • Phone: 913-232-3010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-77665-032
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: