Healthcare Provider Details

I. General information

NPI: 1295757524
Provider Name (Legal Business Name): KELLY FRANCES GARDNER MS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 RIVER RD
LINCOLN ME
04457-4012
US

IV. Provider business mailing address

99 RIVER RD
LINCOLN ME
04457-4012
US

V. Phone/Fax

Practice location:
  • Phone: 207-403-2000
  • Fax: 207-623-5718
Mailing address:
  • Phone: 207-403-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1613
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: