Provider Demographics
NPI:1083299085
Name:GARDNER, CHRISSY (NP-C)
Entity Type:Individual
Prefix:
First Name:CHRISSY
Middle Name:
Last Name:GARDNER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 CEDAR TRAIL LN
Mailing Address - Street 2:
Mailing Address - City:HARVEST
Mailing Address - State:AL
Mailing Address - Zip Code:35749-9659
Mailing Address - Country:US
Mailing Address - Phone:256-655-1860
Mailing Address - Fax:
Practice Address - Street 1:359 CEDAR TRAIL LN
Practice Address - Street 2:
Practice Address - City:HARVEST
Practice Address - State:AL
Practice Address - Zip Code:35749-9659
Practice Address - Country:US
Practice Address - Phone:256-655-1860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-136585163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse