Keshawn Gardner, CSFA

Primary specialty

Surgical AssistantTaxonomy code 246ZC0007X

License

157289 Issued in IL

Practice address

1248 Berry LN
Flossmoor, IL 60422

Phone

(708) 215-1604

NPI assigned

Mar 4, 2015

Last updated

Jul 25, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

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.

• Chief Surgical Assistants

  • Surgical Assistant
  • Flossmoor, IL
  • NPI 1245744515
  NPD (past) Authorized official

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

{
    "created_epoch": "1425427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532476800000",
    "number": "1437541190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1248 BERRY LN",
            "city": "FLOSSMOOR",
            "state": "IL",
            "postal_code": "604221410",
            "telephone_number": "708-215-1604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1248 BERRY LN",
            "city": "FLOSSMOOR",
            "state": "IL",
            "postal_code": "60422",
            "telephone_number": "708-215-1604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "KESHAWN",
        "credential": "CSFA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-03-04",
        "last_updated": "2018-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "IL",
            "license": "157289",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victor P Fuller
• Dynata Charles Funderburg, M.A.
• Leah Marie Galderio
• Delaney Renee Galvin, MOT
• Jennifer A Gardner, CRNA
• Annalisa Garetto
• Ryan Edward Garwood, DO
• Cynthia Jane Gerecke, M.S. CCC-SLP/L
• Tolaya Geredine, LCPC
• Amy Danielle Gervais

• Surgical Assistant in Flossmoor, IL
• Providers in Flossmoor, IL by specialty
• Surgical Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2018; 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.