Provider Demographics
NPI:1619852670
Name:GARDNER-LYNCH, ANJANETTE JO
Entity type:Individual
Prefix:
First Name:ANJANETTE
Middle Name:JO
Last Name:GARDNER-LYNCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 N CAMPBELL ST UNIT 66
Mailing Address - Street 2:
Mailing Address - City:WILLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77378-6223
Mailing Address - Country:US
Mailing Address - Phone:936-647-8429
Mailing Address - Fax:
Practice Address - Street 1:13291 HIDDEN TRAIL CT
Practice Address - Street 2:
Practice Address - City:WILLIS
Practice Address - State:TX
Practice Address - Zip Code:77318-4282
Practice Address - Country:US
Practice Address - Phone:936-647-8429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care