Individual
MS. HEIDI ANN GALLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
908 DUPONT RD STE 100, LOUISVILLE, KY 40207-4602
(502) 883-3147
(502) 891-0028
Mailing address
908 DUPONT RD STE 100, LOUISVILLE, KY 40207-4602
(502) 883-3147
(502) 891-0028
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
3421P
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000187104
ANTHEM
—
01
—
021102300
FEDERAL BLACK LUNG
—
01
—
1161890
PASSPORT
—
01
—
2439614000
PASSPORT ADVANTAGE
—
01
—
K075320
MEDICARE PTAN
KY
Enumeration date
11/08/2005
Last updated
08/11/2021
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