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General NPI Number Information
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NPI Number | 1508381039
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Entity Type | Individual
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Provider Name | YORVOLL GARDNER NP
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Gender | Female
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Dates
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Enumeration Date | 08/05/2017
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Last Update Date | 01/20/2025
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Provider Practice Location Address
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Address Line | 637 DUNN RD STE 102
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City | HAZELWOOD
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State | MO
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Zip | 63042-1747
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Country | US
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Telephone | 314-817-2000
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Fax | 314-817-2350
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Provider Business Mailing Address
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Address Line | PO BOX 776084
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City | CHICAGO
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State | IL
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Zip | 60677-6084
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Country | US
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Telephone | 314-817-2000
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Fax | 314-817-2350
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 2017029363
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | AG07170077
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License Number State | MO
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