Provider Demographics
NPI:1841577301
Name:GARDNER, KERRY LYNN (LPN)
Entity Type:Individual
Prefix:MS
First Name:KERRY
Middle Name:LYNN
Last Name:GARDNER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-4568
Mailing Address - Country:US
Mailing Address - Phone:360-736-0112
Mailing Address - Fax:360-736-9252
Practice Address - Street 1:14016 A ST S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-4662
Practice Address - Country:US
Practice Address - Phone:253-503-3649
Practice Address - Fax:253-292-1629
Is Sole Proprietor?:No
Enumeration Date:2011-11-12
Last Update Date:2023-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00058062164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse