Individual
BRELAN MIKAL GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
296 EASTSIDE DR, NEWTON, MS 39345-8036
(601) 228-8985
Mailing address
PO BOX 608, PHILADELPHIA, MS 39350-0608
(662) 694-0035
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
905732
MS
Other
Enumeration date
01/03/2023
Last updated
12/07/2023
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