Provider Demographics
NPI:1508282625
Name:GARDNER, CALIDA LATONIA (CNM)
Entity Type:Individual
Prefix:MRS
First Name:CALIDA
Middle Name:LATONIA
Last Name:GARDNER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MISS
Other - First Name:CALIDA
Other - Middle Name:LATONIA
Other - Last Name:BANKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18220 STATE HIGHWAY 249 STE 370
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-4349
Mailing Address - Country:US
Mailing Address - Phone:832-698-5515
Mailing Address - Fax:832-698-5516
Practice Address - Street 1:18220 STATE HIGHWAY 249 STE 370
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4349
Practice Address - Country:US
Practice Address - Phone:832-698-5515
Practice Address - Fax:832-698-5516
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE120052367A00000X
TX1074546367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife