Healthcare Provider Details

I. General information

NPI: 1134628985
Provider Name (Legal Business Name): KENDRA S GARDNER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KENDRA BURRESS MILLER NP

II. Dates (important events)

Enumeration Date: 02/07/2018
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 MORRIS ST
MOSS POINT MS
39563-2838
US

IV. Provider business mailing address

4730 MORRIS ST
MOSS POINT MS
39563-2838
US

V. Phone/Fax

Practice location:
  • Phone: 228-285-0361
  • Fax: 228-285-0356
Mailing address:
  • Phone: 228-285-0361
  • Fax: 228-285-0356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number902266
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number902266
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: