Stephanie Jeannette Gardner

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

APN0000029252 Issued in TN

Practice address

130 Commons Dr
Martin, TN 38237-3879

Phone

(731) 587-5138

NPI assigned

Jul 13, 2021

Last updated

Jul 13, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Martin Children's Clinic, LLC

  • Rural Health Clinic/Center
  • Martin, TN
  • NPI 1194049064

  Pediatrics

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626134400000",
    "number": "1346812013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3970 HIGHWAY 118",
            "city": "DRESDEN",
            "state": "TN",
            "postal_code": "382255905",
            "telephone_number": "731-514-5935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 COMMONS DR",
            "city": "MARTIN",
            "state": "TN",
            "postal_code": "382373879",
            "telephone_number": "731-587-5138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "STEPHANIE",
        "middle_name": "JEANNETTE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-13",
        "last_updated": "2021-07-13",
        "certification_date": "2021-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "TN",
            "license": "APN0000029252",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carolyn Diana Fulcher, LCSW
• Debra Fulcher, M.S.
• Coleen C Garcia, PT
• Faustino H. Garcia Jr., PHYSICAL THERAPIST
• Kimberly Gardner
• Perseveranda Garma, PT
• Karla L Garner, PHARMD
• Gary Brown (Children's Treatment Center)
• Gastroenterology Associates P C
• Generations Health Assoc.,Inc.Dba Generations Mental Health Center

• Pediatric Nurse Practitioner in Martin, TN
• Providers in Martin, TN by specialty
• Pediatric Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.