# K A GARDNER PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609241488
- **Authorized official:** KIMBERLEY GARDNER PMHNP (OWNER/PROVIDER)
- **Authorized official phone:** (817) 269-1169

## Contact information

- **Practice address:** 3109 6TH AVE STE B, FORT WORTH, TX 76110-3800
- **Practice address phone:** (682) 312-7339
- **Mailing address:** 1210 POWDER RIVER TRL, SOUTHLAKE, TX 76092-3231

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | AP129382 | TX | Yes |

## Other

- **Enumeration date:** 12/05/2015
- **Last updated:** 12/05/2015