Kristin Kay Gardner, CASAC-T

Primary specialty

Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X

License

231012342 Issued in NY

Practice address

20 Community LN
Liberty, NY 12754-2851

Phone

(845) 867-4304

NPI assigned

Dec 15, 2022

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1671062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671062400000",
    "number": "1992417570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2875 ROUTE 35",
            "city": "KATONAH",
            "state": "NY",
            "postal_code": "105363181",
            "telephone_number": "914-666-0191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 COMMUNITY LN",
            "city": "LIBERTY",
            "state": "NY",
            "postal_code": "127542851",
            "telephone_number": "845-867-4304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "KRISTIN",
        "middle_name": "KAY",
        "credential": "CASAC-T",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-15",
        "last_updated": "2022-12-15",
        "certification_date": "2022-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "NY",
            "license": "231012342",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "kgardner@lexingtonctr.org",
            "affiliation": "N",
            "address_1": "20 Community Ln",
            "city": "Liberty",
            "state": "NY",
            "country_code": "US",
            "postal_code": "127542851",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Donna Marie Funcheon, RN
• Susan Faith Furgison, RN
• Jamie S Gandulla, RN
• April Garcia, PTA
• Willan Smith Garcia, PT
• Gelsomino and Davis Speech and Occupational Therapy
• Gelsomino and Davis Speech and Occupational Therapy
• Matthew Goetz, RN
• Herman Gonzalez, AAS
• Olivia Gorr, LMSW

• Addiction Medicine (Family Medicine) Physician in Liberty, NY
• Providers in Liberty, NY by specialty
• Addiction Medicine (Family Medicine) Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.