Provider Demographics
NPI:1508381039
Name:GARDNER, YORVOLL (NP)
Entity type:Individual
Prefix:MRS
First Name:YORVOLL
Middle Name:
Last Name:GARDNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776084
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6084
Mailing Address - Country:US
Mailing Address - Phone:314-817-2000
Mailing Address - Fax:314-817-2350
Practice Address - Street 1:637 DUNN RD STE 102
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-1747
Practice Address - Country:US
Practice Address - Phone:314-817-2000
Practice Address - Fax:314-817-2350
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-05
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017029363363LA2200X
MOAG07170077207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine