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General NPI Number Information
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NPI Number | 1811153729
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Entity Type | Individual
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Provider Name | THOMAS CHARLES GARDNER APN
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Gender | Male
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Dates
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Enumeration Date | 07/30/2008
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Last Update Date | 06/29/2011
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Provider Practice Location Address
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Address Line | 2642 STATE ROUTE 76
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City | WILLOW SPRINGS
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State | MO
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Zip | 65793-8254
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Country | US
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Telephone | 417-469-5124
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Fax | 417-469-1165
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Provider Business Mailing Address
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Address Line | 2642 STATE ROUTE 76
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City | WILLOW SPRINGS
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State | MO
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Zip | 65793-8254
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Country | US
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Telephone | 417-469-5124
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Fax | 417-469-1165
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN
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License Number State | MO
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