Provider Demographics
NPI:1720552268
Name:GARDNER, BRITTANY CARNEY (FNP-C)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:CARNEY
Last Name:GARDNER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:KAYE
Other - Last Name:CARNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39441-0247
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1410 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-4243
Practice Address - Country:US
Practice Address - Phone:601-425-4860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-17
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903051363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily