Individual
JENNIFER GAIL GALLAWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
821 S PINE ST, STILLWATER, OK 74074-4350
(405) 533-1332
(405) 533-1704
Mailing address
821 S PINE ST, STILLWATER, OK 74074-4350
(405) 533-1332
(405) 533-1704
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
R0073110
OK
363L00000X
Nurse Practitioner
R0073110
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110236658
RAILROAD MEDICARE
OH
05
—
200057450A
—
OK
01
—
730929415001
BCBS OF OKLAHOMA
OK
Enumeration date
06/12/2006
Last updated
06/30/2016
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