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Organization
K A GARDNER PLLC
Active
Organization
K A GARDNER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLEY GARDNER PMHNP (OWNER/PROVIDER)
(817) 269-1169
Entity
Organization
Contact information
Practice address
3109 6TH AVE STE B, FORT WORTH, TX 76110-3800
(682) 312-7339
Mailing address
1210 POWDER RIVER TRL, SOUTHLAKE, TX 76092-3231
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP129382
TX
Other
Enumeration date
12/05/2015
Last updated
12/05/2015
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