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General NPI Number Information
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NPI Number | 1962939678
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Entity Type | Individual
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Provider Name | KARI GARDNER NP
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Gender | Female
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Dates
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Enumeration Date | 05/12/2017
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Last Update Date | 05/12/2017
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Provider Practice Location Address
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Address Line | 4921 PARKVIEW PLACE MS #90-32-683
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City | SAINT LOUIS
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State | MO
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Zip | 63110
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Country | US
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Telephone | 314-362-2340
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Fax |
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Provider Business Mailing Address
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Address Line | 531 SUNSET DR
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City | EDWARDSVILLE
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State | IL
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Zip | 62025
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Country | US
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Telephone | 217-433-3267
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 2017012598
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License Number State | MO
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