Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 52158 | KY |
NPI | 1194168666 |
---|---|
Provider Name | Kourtney G. Gardner |
First Address | Bowling Green, KY 42101-1708 |
Second Address | Bowling Green, KY 42101-4000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2013 |
Last Update Date | 29/05/2019 |