Provider Demographics
NPI:1730270463
Name:GARDNER, CATHERINE WILLIAMS (ARNP)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:WILLIAMS
Last Name:GARDNER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 N GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-1818
Mailing Address - Country:US
Mailing Address - Phone:405-632-6688
Mailing Address - Fax:
Practice Address - Street 1:11220 N ROCKWELL AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-2725
Practice Address - Country:US
Practice Address - Phone:405-632-6688
Practice Address - Fax:405-634-9611
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013042503363LX0001X
FL9327843363LX0001X
OKR0058989363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200095940AMedicaid
OKP00429321OtherRR MEDICARE
OK248630603Medicare PIN
P00359Medicare UPIN