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NPI Code Detail

MEDICARE: GLEN GARDNER

MEDICARE: GLEN 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
1103K00000XBehavior AnalystBACB1251512NC

General Provider Information

NPI Number : 1518813807
Entity Type Code : Individual
Provider Name (Legal Business Name) : GLEN GARDNER
Provider Business Mailing Address
First Line : 3710 JOHN PLATT DR
Second Line :
City : MOREHEAD CITY
State : NC
Zip : 28557-4372
Country : US
Telephone Number : 252-777-3140
Fax Number : 833-487-1086
Provider Business Practice Location Address
First Line : 3710 JOHN PLATT DR
Second Line :
City : MOREHEAD CITY
State : NC
Zip : 28557-4372
Country : US
Telephone Number : 252-777-3140
Fax Number : 833-487-1086
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2026
Last Update Date : 03/09/2026

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Directions to “ GLEN GARDNER ” Practice Location

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