Provider Demographics
NPI:1245649516
Name:GARDUNO, KIMBERLY (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:GARDUNO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:WILKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:601 CLARA BARTON BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-5755
Mailing Address - Country:US
Mailing Address - Phone:972-276-1779
Mailing Address - Fax:972-276-5560
Practice Address - Street 1:601 CLARA BARTON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5755
Practice Address - Country:US
Practice Address - Phone:972-276-1779
Practice Address - Fax:972-276-5560
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-12
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09211363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant