Provider Demographics
NPI:1689017972
Name:GARDNER, KATHI SUE (FNP-C)
Entity type:Individual
Prefix:MS
First Name:KATHI
Middle Name:SUE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333W MARCH LN A1
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5263
Mailing Address - Country:US
Mailing Address - Phone:209-475-8144
Mailing Address - Fax:209-474-7679
Practice Address - Street 1:2333W MARCH LN A1
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5263
Practice Address - Country:US
Practice Address - Phone:209-475-8144
Practice Address - Fax:209-474-7679
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21599163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice