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

Kevin Hall Gardner, DO

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1639490386

Kevin Hall Gardner, DO is a Dermatology in Provo, Utah. Qualified in 2010, 16 years ago. Practices with Ihc Health Services Inc, a 3,947-clinician group and accepts Medicare assignment. Licensed in Minnesota and Utah.

Years since qualifying
16
Licensed in
MN, UT
In the registry since
2010
Specialties on file
4
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

1055 N 500 W Ste 111
Provo, UT 84604-3305
Phone: (801) 374-8999
Fax: (801) 429-8063
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X · Licence 9332631-1204 (UT)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X
Dermatology Physician Taxonomy 207N00000X · Licence 54109 (MN)
MOHS-Micrographic Surgery Physician Taxonomy 207ND0101X · Licence 9332631-1204 (UT)

Record details

NPI number1639490386
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorNo
NPI enumeratedJune 17, 2010
Last updated in NPPESSeptember 8, 2021
Certification dateSeptember 8, 2021
Mailing address1055 N 500 W, Attn: Credentialing, Provo, UT 84604-3305

Medicare enrollment

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

Medicare specialtyDERMATOLOGY
Medical schoolOTHER
Graduated 2010 (16 years in practice)
Group practice Ihc Health Services Inc — 3947 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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