Provider Demographics
NPI:1407451602
Name:GARDNER, KANSAS RENEE
Entity Type:Individual
Prefix:
First Name:KANSAS
Middle Name:RENEE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 CENTERPOINT RD
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:OH
Mailing Address - Zip Code:45656-9002
Mailing Address - Country:US
Mailing Address - Phone:740-794-0037
Mailing Address - Fax:
Practice Address - Street 1:3650 CENTERPOINT RD
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:OH
Practice Address - Zip Code:45656-9002
Practice Address - Country:US
Practice Address - Phone:740-794-0037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program