Healthcare Provider Details

I. General information

NPI: 1619852670
Provider Name (Legal Business Name): ANJANETTE JO GARDNER-LYNCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2025
Last Update Date: 08/31/2025
Certification Date: 08/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13291 HIDDEN TRAIL CT
WILLIS TX
77318-4282
US

IV. Provider business mailing address

609 N CAMPBELL ST UNIT 66
WILLIS TX
77378-6223
US

V. Phone/Fax

Practice location:
  • Phone: 936-647-8429
  • Fax:
Mailing address:
  • Phone: 936-647-8429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: