Provider Demographics
NPI:1720383102
Name:GARDNER, SHARONDA
Entity Type:Individual
Prefix:
First Name:SHARONDA
Middle Name:
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 1:400 HARRISON ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-6916
Mailing Address - Country:US
Mailing Address - Phone:870-793-6774
Mailing Address - Fax:870-793-1997
Practice Address - Street 1:400 HARRISON ST
Practice Address - Street 2:SUITE 205
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-6916
Practice Address - Country:US
Practice Address - Phone:870-793-6774
Practice Address - Fax:870-793-1997
Is Sole Proprietor?:No
Enumeration Date:2011-01-17
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator