Provider Demographics
NPI:1134628985
Name:GARDNER, KENDRA S (NP)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:S
Last Name:GARDNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:
Other - Last Name:BURRESS MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:3702 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MOSS POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39563-6218
Mailing Address - Country:US
Mailing Address - Phone:228-769-1166
Mailing Address - Fax:
Practice Address - Street 1:3702 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39563
Practice Address - Country:US
Practice Address - Phone:228-769-1166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902266363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner