Kenzie Gardner, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4704335952 Issued in MI

Practice address

5885 S Main St Ste 1
Clarkston, MI 48346-2981

Phone

(614) 507-3765

NPI assigned

Jan 11, 2018

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Main Street Dermatology PLLCGroup PAC ID 3476917766, 5 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Trinity Health Ann Arbor Hospital Hospital, Ann Arbor, MI, CCN 230156

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

Practice roles

Locations

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

• Main Street Dermatology, PLLC

  • Dermatology Physician
  • Clarkston, MI
  • NPI 1881371946
  Medicare reassignment Care Compare group NPD Authorized official
• Jennifer Caudill, MD PLLC

  • Dermatology Physician
  • Clarkston, MI
  • NPI 1477841245
  Medicare reassignment NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St Joseph Mercy Hospital

  • General Acute Care Hospital
  • Ypsilanti, MI
  • NPI 1780658443
  Care Compare affiliation

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

{
    "created_epoch": "1515628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763683200000",
    "number": "1720596802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5885 S MAIN ST STE 1",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "483462981",
            "telephone_number": "248-238-8059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5885 S MAIN ST STE 1",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "483462981",
            "telephone_number": "614-507-3765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "KENZIE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-11",
        "last_updated": "2025-11-21",
        "certification_date": "2025-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704335952",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NP LICENSE",
            "identifier": "4704335952",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lynnette Gallant, MS, LLP
• Sonam Gandhi, PT
• Robert Garchow, LCSW
• Kelsiana Rose Gardella, RBT
• Jordyn Nicole Gardner, CMSSW
• Jonathan G Garretson, O.D.
• Elaina Nicole Garvonic, PHARMD
• Garwood Associates L L C
• Stanley B. Garwood Jr., MSW LMSW
• Stephanie Gaumer, LMSW

• Family Nurse Practitioner in Clarkston, MI
• Providers in Clarkston, MI by specialty
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.