Provider Demographics
NPI:1669846812
Name:GARDNER, ALEX M (APRN)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:M
Last Name:GARDNER
Suffix:
Gender:M
Credentials:APRN
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Other - First Name:
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Mailing Address - Street 1:5000 LONG PRAIRIE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2797
Mailing Address - Country:US
Mailing Address - Phone:972-420-1776
Mailing Address - Fax:972-221-8685
Practice Address - Street 1:5000 LONG PRAIRIE RD STE 100
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2797
Practice Address - Country:US
Practice Address - Phone:972-420-1776
Practice Address - Fax:972-221-8685
Is Sole Proprietor?:No
Enumeration Date:2015-11-25
Last Update Date:2023-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1076140363L00000X
SC20122363L00000X
GARN276968363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner