Provider Demographics
NPI:1821864554
Name:GARDNER, ALISON LEIGH (PMHNP)
Entity Type:Individual
Prefix:MS
First Name:ALISON
Middle Name:LEIGH
Last Name:GARDNER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64211 TUMALO RIM DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-5222
Mailing Address - Country:US
Mailing Address - Phone:541-419-3175
Mailing Address - Fax:
Practice Address - Street 1:151 SW SHEVLIN HIXON DR STE 201
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3233
Practice Address - Country:US
Practice Address - Phone:541-797-3631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10018452363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health