Provider Demographics
NPI:1790869071
Name:GARDNER, JENNIE (APRN)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:
Last Name:GARDNER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:430 E PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-1816
Mailing Address - Country:US
Mailing Address - Phone:859-234-9400
Mailing Address - Fax:859-234-3778
Practice Address - Street 1:784 HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:FRENCHBURG
Practice Address - State:KY
Practice Address - Zip Code:40322-8123
Practice Address - Country:US
Practice Address - Phone:606-768-9190
Practice Address - Fax:606-768-9180
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2021-02-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY3003792363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78009875Medicaid
P79131Medicare UPIN
KYK024521Medicare PIN
KY78009875Medicaid
KYK024522Medicare PIN