Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 8009-33 | WI |
N | 363LA2100X | Nurse Practitioner - Acute Care | 8009-33 | WI |
N | 363LA2200X | Nurse Practitioner - Adult Health | 8009-33 | WI |
N | 363LG0600X | Nurse Practitioner - Gerontology | 8009-33 | WI |
NPI | 1003325051 |
---|---|
Provider Name | Dr. Kelly Ann Gardner |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53792 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2017 |
Last Update Date | 13/01/2021 |