Healthcare Provider Details

I. General information

NPI: 1790869071
Provider Name (Legal Business Name): JENNIE GARDNER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

784 HIGHWAY 36
FRENCHBURG KY
40322-8123
US

IV. Provider business mailing address

430 E PLEASANT ST
CYNTHIANA KY
41031-1816
US

V. Phone/Fax

Practice location:
  • Phone: 606-768-9190
  • Fax: 606-768-9180
Mailing address:
  • Phone: 859-234-9400
  • Fax: 859-234-3778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3003792
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: