MEDICARE: JODIE KATHLEEN GARDNER RN, LCDC, LPC

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
1	101YP2500X	Professional Counselor	20423	CA
2	101YP2500X	Professional Counselor	77489	TX
3	164X00000X	Licensed Vocational Nurse	179319	TX
4	251J00000X	Nursing Care Agency	940974	TX

General Provider Information

NPI Number	:	1821599796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODIE KATHLEEN GARDNER RN, LCDC, LPC

Provider Business Mailing Address
First Line	:	PO BOX 24449
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-0589
Country	:	US
Telephone Number	:	833-351-8255
Fax Number	:

Provider Business Practice Location Address
First Line	:	2518 HELENA CIRCLE
Second Line	:
City	:	ABILENE
State	:	TX
Zip	:	79606
Country	:	US
Telephone Number	:	325-280-1257
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2018
Last Update Date	:	01/26/2026

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