Provider Demographics
NPI:1568669489
Name:GARDNER, DEBORAH KIM (APRN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:KIM
Last Name:GARDNER
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:MRS
Other - First Name:DEBORAH
Other - Middle Name:KIM
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN, FNP
Mailing Address - Street 1:590 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SNOWFLAKE
Mailing Address - State:AZ
Mailing Address - Zip Code:85937-5228
Mailing Address - Country:US
Mailing Address - Phone:928-536-7519
Mailing Address - Fax:928-532-2139
Practice Address - Street 1:590 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SNOWFLAKE
Practice Address - State:AZ
Practice Address - Zip Code:85937-5228
Practice Address - Country:US
Practice Address - Phone:928-536-7519
Practice Address - Fax:928-532-2139
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY576363LF0000X
AK1086363LF0000X
AZ286441363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily