Individual
KENNETH A. GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
150 FAIRVIEW COURT, EMINENCE, KY 40019
(502) 845-5672
(502) 845-1402
Mailing address
100 E LIBERTY ST STE 800, LOUISVILLE, KY 40202-1428
(502) 845-5672
(502) 845-1402
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
22049
KY
208D00000X
General Practice Physician
22049
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000048271
ANTHEM
KY
01
—
00000048271
ANTHEM
—
01
—
0100485
UHC
—
05
—
64220494
—
KY
Enumeration date
10/17/2005
Last updated
03/15/2018
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