Jeremy Gardner, APRN-CNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

54041 Issued in ID

Practice address

425 W Bannock St
Boise, ID 83702-6035

Phone

(208) 343-6458

NPI assigned

Jul 6, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Feb 27, 2025 through Feb 27, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Interoperability endpoints

• Direct secure messaging: jeremy.gardner.1@21889.direct.athenahealth.com

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

{
    "created_epoch": "1657065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707696000000",
    "number": "1902539976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 W BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837026035",
            "telephone_number": "208-343-6458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 W BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837026035",
            "telephone_number": "208-343-6458"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1200 Garrity Blvd",
            "address_purpose": "LOCATION",
            "city": "Nampa",
            "state": "ID",
            "postal_code": "836873402",
            "country_code": "US",
            "telephone_number": "208-695-2107",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "520 S Eagle Rd",
            "address_purpose": "LOCATION",
            "city": "Meridian",
            "state": "ID",
            "postal_code": "836426351",
            "country_code": "US",
            "telephone_number": "208-706-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "190 E Bannock St",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837126241",
            "country_code": "US",
            "telephone_number": "208-381-2222",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2235 E Gala St",
            "address_purpose": "LOCATION",
            "city": "Meridian",
            "state": "ID",
            "postal_code": "836428026",
            "country_code": "US",
            "telephone_number": "208-489-1431",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9850 W St Lukes Dr",
            "address_purpose": "LOCATION",
            "city": "Nampa",
            "state": "ID",
            "postal_code": "836877912",
            "country_code": "US",
            "telephone_number": "208-505-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "JEREMY",
        "credential": "APRN-CNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-06",
        "last_updated": "2024-02-12",
        "certification_date": "2024-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "54041",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "ID",
            "license": "54041",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katie Garcin, L/ATC
• Ashley Kay Gardiner
• Cassie Mikaila Gardner-Gould
• Annalisa Gardner
• Cody Wade Gardner
• Jessica Ann Gardner
• Kayla Whitney Gardner, NP
• Kevin Gardner
• Lizabeth Gardner, PT
• Marshall Gardner, PA-C

• Nurse Practitioner in Boise, ID
• Providers in Boise, ID by specialty
• Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.