Active NPI
Jacqueline Gardner, FNP
- Pediatric Nurse Practitioner
- Hilo, HI
National Provider Identifier
1891920567
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- APRN 17
- Practice address
- 45 Mohouli St
Hilo, HI 96720-7210 - Phone
- (808) 896-5569
- NPI assigned
- May 23, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | AMD 59 | HI | |
| Pediatric Nurse Practitioner | 363LP0200X | APRN 17 | HI | Primary |
Addresses
Primary practice location
45 Mohouli St
Hilo, HI 96720-7210
Mailing address
HC 2 Box 6074
Keaau, HI 96749-8300
Phone (808) 982-7809
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AMD 59 | HI | MD | Medical Physician Assistant |
| APRN 17 | HI | MD | Pediatric Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1243036800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319587200000",
"number": "1891920567",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "HC 2 BOX 6074",
"city": "KEAAU",
"state": "HI",
"postal_code": "967498300",
"telephone_number": "808-982-7809"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "45 MOHOULI ST",
"city": "HILO",
"state": "HI",
"postal_code": "967207210",
"telephone_number": "808-896-5569"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GARDNER",
"first_name": "JACQUELINE",
"credential": "FNP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-05-23",
"last_updated": "2011-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "HI",
"license": "AMD 59",
"primary": false
},
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "HI",
"license": "APRN 17",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hilo, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.