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NPI Code Detail

MEDICARE: MARY KATHERINE GARDNER

MEDICARE: MARY KATHERINE GARDNER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorP2404010AR

General Provider Information

NPI Number : 1073288569
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY KATHERINE GARDNER
Provider Business Mailing Address
First Line : 2809 FOREST HOME RD
Second Line :
City : JONESBORO
State : AR
Zip : 72401-5320
Country : US
Telephone Number : 866-972-1268
Fax Number :
Provider Business Practice Location Address
First Line : 10311 W MARKHAM ST
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72205-2135
Country : US
Telephone Number : 501-781-2230
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2021
Last Update Date : 05/29/2025

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