Provider Demographics
NPI:1295757524
Name:GARDNER, KELLY FRANCES (MS PA-C)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:FRANCES
Last Name:GARDNER
Suffix:
Gender:F
Credentials:MS PA-C
Other - Prefix:
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Mailing Address - Street 1:87 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:ORONO
Mailing Address - State:ME
Mailing Address - Zip Code:04473-3653
Mailing Address - Country:US
Mailing Address - Phone:207-385-5154
Mailing Address - Fax:
Practice Address - Street 1:99 RIVER RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:ME
Practice Address - Zip Code:04457-4012
Practice Address - Country:US
Practice Address - Phone:207-403-2000
Practice Address - Fax:207-623-5718
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP2042235Z00000X
MEPA1613363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist