Provider Demographics
NPI:1427779438
Name:GARDNER, ALICIA DAWN (CNP)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:DAWN
Last Name:GARDNER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5124 WHITE OAK RD NE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43106-9612
Mailing Address - Country:US
Mailing Address - Phone:740-572-6096
Mailing Address - Fax:
Practice Address - Street 1:272 HOSPITAL RD STE 270
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-9031
Practice Address - Country:US
Practice Address - Phone:740-779-4550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0032257363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care