Individual
CORDIE SHAKERA GARDNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1510 BYRUM RD, BLYTHEVILLE, AR 72315-8033
(870) 532-2600
Mailing address
1510 BYRUM RD, BLYTHEVILLE, AR 72315-8033
(870) 532-2600
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
03/27/2012
Last updated
03/27/2012
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