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General NPI Number Information
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NPI Number | 1588155717
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Entity Type | Individual
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Provider Name | JESSICA MARIE GARDNER FNP
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Gender | Female
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Dates
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Enumeration Date | 05/23/2018
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Last Update Date | 07/10/2024
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Provider Practice Location Address
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Address Line | 300 MAIN ST STE 201
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-2404
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Country | US
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Telephone | 970-413-3776
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Fax | 833-536-1752
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Provider Business Mailing Address
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Address Line | 73-1281 AWAKEA ST
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City | KAILUA KONA
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State | HI
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Zip | 96740-9571
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Country | US
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Telephone | 970-413-3776
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Fax | 833-536-1752
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN.0182251
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN.0993930-NP
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License Number State | CO
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