Provider Demographics
NPI:1194168666
Name:GARDNER, KOURTNEY G (MD)
Entity type:Individual
Prefix:
First Name:KOURTNEY
Middle Name:G
Last Name:GARDNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 PARK ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1708
Mailing Address - Country:US
Mailing Address - Phone:270-780-0560
Mailing Address - Fax:270-780-0467
Practice Address - Street 1:2724 NASHVILLE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-4000
Practice Address - Country:US
Practice Address - Phone:270-780-0560
Practice Address - Fax:270-780-0467
Is Sole Proprietor?:No
Enumeration Date:2013-04-15
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY52158207K00000X
OH35.128551208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology