Active NPI
Jessica Marie Gardner
- Pharmacy Technician
- Fort Dodge, IA
National Provider Identifier
1912461534
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy Technician
- License
- 12072
- Practice address
- 1114 Central Ave
Fort Dodge, IA 50501-4004 - Phone
- (515) 573-3431
- Fax
- (515) 573-3431
- NPI assigned
- Jan 28, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy Technician | 183700000X | 12072 | IA | Primary |
Addresses
Primary practice location
1114 Central Ave
Fort Dodge, IA 50501-4004
Mailing address
919 S 29TH St
Fort Dodge, IA 50501-6332
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12072 | IA | MD | Pharmacy Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Daniel Pharmacy Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1548633600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548633600000",
"number": "1912461534",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "919 S 29TH ST",
"city": "FORT DODGE",
"state": "IA",
"postal_code": "505016332"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1114 CENTRAL AVE",
"city": "FORT DODGE",
"state": "IA",
"postal_code": "505014004",
"telephone_number": "515-573-3431",
"fax_number": "515-573-3431"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GARDNER",
"first_name": "JESSICA",
"middle_name": "MARIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-01-28",
"last_updated": "2019-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "183700000X",
"taxonomy_group": "",
"desc": "Pharmacy Technician",
"state": "IA",
"license": "12072",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Dodge, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.