Provider Demographics
NPI:1720816382
Name:GARDYNSKI, KELLY ANNE (DNP, APRN, CPNP-PC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANNE
Last Name:GARDYNSKI
Suffix:
Gender:
Credentials:DNP, APRN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:473 W ARMY TRAIL RD STE 103
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2674
Mailing Address - Country:US
Mailing Address - Phone:630-529-6969
Mailing Address - Fax:
Practice Address - Street 1:473 W ARMY TRAIL RD STE 103
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2674
Practice Address - Country:US
Practice Address - Phone:630-529-6969
Practice Address - Fax:630-529-5993
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.030113363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics