Provider Demographics
NPI:1114712338
Name:GALLAGHER, BETHANY GRACE (DO)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:GRACE
Last Name:GALLAGHER
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6705 LONGWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CAMMACK VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:72207-2728
Mailing Address - Country:US
Mailing Address - Phone:501-687-3620
Mailing Address - Fax:
Practice Address - Street 1:259 1ST ST
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3957
Practice Address - Country:US
Practice Address - Phone:516-663-8443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program