Provider Demographics
NPI:1588879662
Name:GARDNER, PATRICIA FIKE (CNM, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:FIKE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:CNM, PMHNP-BC
Other - Prefix:
Other - First Name:PATTI
Other - Middle Name:FIKE
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNM, PMHNP-BC
Mailing Address - Street 1:4444 S 86TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9253
Mailing Address - Country:US
Mailing Address - Phone:402-476-7557
Mailing Address - Fax:
Practice Address - Street 1:4444 S 86TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9253
Practice Address - Country:US
Practice Address - Phone:307-286-0498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2020-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY14082.0253367A00000X, 363LP0808X
NE111008367A00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY10489Medicare PIN