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General NPI Number Information
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NPI Number | 1184237075
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Entity Type | Individual
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Provider Name | KELLY ANN GARDINER PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/28/2020
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 580 N WICKHAM RD STE C
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City | MELBOURNE
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State | FL
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Zip | 32935-8400
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Country | US
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Telephone | 321-255-7118
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Fax | 321-255-8391
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Provider Business Mailing Address
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Address Line | PO BOX 361095
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City | MELBOURNE
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State | FL
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Zip | 32936-1095
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9117668
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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