Individual
KELLY MARTIN GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.N
Contact information
Practice address
1035 CRESWELL AVE, SHREVEPORT, LA 71101-3917
(318) 676-5623
Mailing address
8200 MAURICE ST, SHREVEPORT, LA 71107-9649
(318) 309-3917
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
RN089405
LA
Other
Enumeration date
06/15/2012
Last updated
06/15/2012
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