Individual
JORDAN LYNNE GALLINIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
511 WINDSOR DR, STILLWATER, OK 74074-6962
(405) 707-0900
Mailing address
PO BOX 802738, KANSAS CITY, MO 64180-7874
(720) 375-2008
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
363A00000X
Physician Assistant
Primary
4896
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000033232
ATHLETIC TRAINING CERTIFICATION
—
Enumeration date
07/02/2018
Last updated
11/18/2022
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