Provider Demographics
NPI:1902792302
Name:GARDNER, DAWSON REILLY (PA-C)
Entity type:Individual
Prefix:
First Name:DAWSON
Middle Name:REILLY
Last Name:GARDNER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 MAGNOLIA LN
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-4832
Mailing Address - Country:US
Mailing Address - Phone:913-439-8261
Mailing Address - Fax:
Practice Address - Street 1:506 3RD ST
Practice Address - Street 2:
Practice Address - City:TRIBUNE
Practice Address - State:KS
Practice Address - Zip Code:67879-9684
Practice Address - Country:US
Practice Address - Phone:620-376-4221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant