Kedisha Ruchel Gardener, FNP
Individual provider Active NPI Family Nurse Practitioner · Albion, IN
NPI 1831836170 · NPPES record last updated May 18, 2022
Key facts
- NPI
- 1831836170
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 71012558A (IN)
- Practice address
- 600 Trail Ridge Rd
Albion, IN 46701-1541 - Phone
- (260) 440-0168
- NPI assigned
- May 18, 2022
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Pike Medical Consultants PC
Practice addresses (Care Compare)
7911 N Michigan Rd
Indianapolis, IN 46268-1915
Phone (317) 956-6288
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220713000675 | IN | Practitioner - Nurse Practitioner | 0941681670 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 71012558A | IN | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Informe Healthcare LLC | Family | Current |
Accepting new patients |
| Pike Medical Consultants PC | Current |
Accepting new patients | |
| Informe Healthcare TN, LLC | Past | Accepting new patients |
Locations
762 N Dan Jones Rd
Avon, IN 46123
Phone (201) 856-0224
7970 W Jefferson Blvd
Fort Wayne, IN 46804
Phone (260) 435-2607
7911 Michigan Rd
Indianapolis, IN 46268
Phone (317) 960-3278
17475 Dugdale Dr
South Bend, IN 46635
Phone (574) 247-7500
2741 W Layton Ave
Ste 106
Milwaukee, WI 53221
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 71012558A | IN | Yes |
Addresses
Primary practice location
600 Trail Ridge Rd
Albion, IN 46701-1541
Mailing address
1633 Anconia CV
Fort Wayne, IN 46845-0138
Phone (260) 440-0168
Other providers in Albion, IN
- DRS. Roush & Will Optometrists Inc
- Rebecca Dundon
- Michael R. Engle
- Sage Evans
- Fischer Pharmacare, LLC
- Mary Beth Getty
- Mariel T Grove
- Donna Hackman
- Stephanie R Hammer
- John P Hayes
All providers in Albion, IN · Family Nurse Practitioner in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 18, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.