Healthcare Provider Details

I. General information

NPI: 1588879662
Provider Name (Legal Business Name): PATRICIA FIKE GARDNER CNM, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PATTI FIKE GARDNER CNM, PMHNP-BC

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 03/07/2020
Certification Date: 03/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 S 86TH ST
LINCOLN NE
68526-9253
US

IV. Provider business mailing address

4444 S 86TH ST
LINCOLN NE
68526-9253
US

V. Phone/Fax

Practice location:
  • Phone: 307-286-0498
  • Fax:
Mailing address:
  • Phone: 402-476-7557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number14082.0253
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number14082.0253
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number111008
License Number StateNE
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number111008
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: