Individual
JULIE GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
971 LAKELAND DR STE 1460, JACKSON, MS 39216-4621
(601) 982-3202
Mailing address
104 GRANFIELD CT, CANTON, MS 39046-5523
(601) 278-1535
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
902476
MS
Other
Enumeration date
01/12/2018
Last updated
01/12/2018
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