Gardner, Casey J

Gardner, Casey J is an individual health care provider with primary practice located at 575 Rivergate Ln Unit 105 , Durango CO 81301-7490. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Surgical, Physician Assistants & Advanced Practice Nursing Providers / Medical. Physician Assistants & Advanced Practice Nursing Providers / Surgical is her primary health care specialty. Gardner, Casey J can be contacted via phone (970) 259-3020.

Contact Information

Primary practice address
575 Rivergate Ln Unit 105 Durango CO 81301-7490
Phone: (970) 259-3020
Fax: (970) 259-9766
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X 10000672A Indiana
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X 0003579 Colorado
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X 10000672A Indiana

Profile Details

NPI number 1629059878
LBN Legal business name Gardner, Casey J
Credentials P.A.C.
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 7th, 2005
Last updated Feb 19th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1629059878 NPPES
Indiana Other 151020TTTT MEDICARE PTAN NUMBER
Indiana Other 151020 MEDICARE PTAN NUMBER
Indiana MEDICAID 9000178409 MEDICARE PTAN NUMBER
Indiana Other P00841261 MEDICARE PTAN NUMBER

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