Provider Demographics
NPI:1326092172
Name:GARDNER, CHRISTOPHER JEFF (FNP-C)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JEFF
Last Name:GARDNER
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 CHEYENNE
Mailing Address - Street 2:PO BOX 9
Mailing Address - City:SATANTA
Mailing Address - State:KS
Mailing Address - Zip Code:67870-8748
Mailing Address - Country:US
Mailing Address - Phone:620-649-2771
Mailing Address - Fax:620-649-2538
Practice Address - Street 1:410 CHEYENNE
Practice Address - Street 2:
Practice Address - City:SATANTA
Practice Address - State:KS
Practice Address - Zip Code:67870-8748
Practice Address - Country:US
Practice Address - Phone:620-649-2771
Practice Address - Fax:620-649-2538
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002018055363LF0000X
KS45845363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1326092172Medicaid
KS200390150AMedicaid
KS45845OtherARNP #
KS14-97622-101OtherRN LICENSE
KS45845OtherARNP #
MO1326092172Medicaid
KS200390150AMedicaid