Provider Demographics
NPI:1588155717
Name:GARDNER, JESSICA MARIE (FNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MARIE
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:73-1281 AWAKEA ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-9571
Mailing Address - Country:US
Mailing Address - Phone:970-413-3776
Mailing Address - Fax:833-536-1752
Practice Address - Street 1:300 MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2404
Practice Address - Country:US
Practice Address - Phone:970-413-3776
Practice Address - Fax:833-536-1752
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0182251163W00000X
COAPN.0993930-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse