Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kenzie Gardner, NP

Individual provider Family Nurse Practitioner · NPI 1720596802

Kenzie Gardner, NP is a Nurse Practitioner in Clarkston, Michigan. Qualified in 2012, 14 years ago. Practices with Main Street Dermatology PLLC, a 5-clinician group and accepts Medicare assignment. Licensed in Michigan.

Years since qualifying
14
Licensed in
MI
In the registry since
2018
What do these letters mean?
NP — Nurse Practitioner
An advanced practice nurse who can diagnose, treat and in most states prescribe.

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Practice location Address checks out

5885 S Main St Ste 1
Clarkston, MI 48346-2981
Phone: (614) 507-3765
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 4704335952 (MI)

Record details

NPI number1720596802
Entity typeIndividual (Type 1)
GenderFemale
Credentials NP
Sole proprietorNo
NPI enumeratedJanuary 11, 2018
Last updated in NPPESNovember 21, 2025
Certification dateNovember 21, 2025
Mailing address5885 S Main St Ste 1, Clarkston, MI 48346-2981

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2012 (14 years in practice)
Group practice Main Street Dermatology Pllc — 5 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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