Individual
CASEY J GARDNER
Active
Individual
CASEY J GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.C.
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
10000672A
IN
363AS0400X
Surgical Physician Assistant
Primary
0003579
CO
363AS0400X
Surgical Physician Assistant
10000672A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
151020
MEDICARE PTAN
CO
01
—
151020TTTT
MEDICARE PTAN NUMBER
IN
05
—
9000178409
—
CO
01
—
P00841261
RAILROAD MEDICARE PTAN NUMBER
IN
Enumeration date
11/07/2005
Last updated
02/19/2024
Update your record
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