1326092172 NPI number — CHRISTOPHER JEFF GARDNER FNP-C

Table of content: CHRISTOPHER JEFF GARDNER FNP-C (NPI 1326092172)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326092172 NPI number — CHRISTOPHER JEFF GARDNER FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARDNER
Provider First Name:
CHRISTOPHER
Provider Middle Name:
JEFF
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326092172
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
410 CHEYENNE
Provider Second Line Business Mailing Address:
PO BOX 9
Provider Business Mailing Address City Name:
SATANTA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67870-8748
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-649-2771
Provider Business Mailing Address Fax Number:
620-649-2538

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
410 CHEYENNE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SATANTA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67870-8748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-649-2771
Provider Business Practice Location Address Fax Number:
620-649-2538
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  2002018055 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 45845 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1326092172 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200390150A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 45845 . This is a "ARNP #" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 14-97622-101 . This is a "RN LICENSE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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