Provider Demographics
NPI:1326589292
Name:GARDNER, JENESI (DNP, APRN)
Entity Type:Individual
Prefix:DR
First Name:JENESI
Middle Name:
Last Name:GARDNER
Suffix:
Gender:F
Credentials:DNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 CORYELL ST
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2765
Mailing Address - Country:US
Mailing Address - Phone:509-315-7400
Mailing Address - Fax:
Practice Address - Street 1:6560 FANNIN ST STE 1540
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2783
Practice Address - Country:US
Practice Address - Phone:713-799-9997
Practice Address - Fax:713-799-2511
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-13
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133546363LF0000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily