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NPI Code Detail

MEDICARE: TIMIA JENELL GARDNER CSW

MEDICARE: TIMIA JENELL GARDNER CSW
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
11041C0700XClinical Social Worker00001179KY

General Provider Information

NPI Number : 1609596428
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIMIA JENELL GARDNER CSW
Provider Business Mailing Address
First Line : 2520 BRIDLE CT
Second Line :
City : LEXINGTON
State : KY
Zip : 40504-1619
Country : US
Telephone Number : 859-536-0548
Fax Number :
Provider Business Practice Location Address
First Line : 1365 DEVONPORT DR
Second Line :
City : LEXINGTON
State : KY
Zip : 40504-1552
Country : US
Telephone Number : 859-229-8027
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2022
Last Update Date : 12/22/2025

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Directions to “ TIMIA JENELL GARDNER CSW” Practice Location

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