Provider Demographics
NPI:1114805710
Name:GALLMON, KISHON
Entity type:Individual
Prefix:
First Name:KISHON
Middle Name:
Last Name:GALLMON
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 1:4512 KIRKWOOD HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5129
Mailing Address - Country:US
Mailing Address - Phone:302-623-7500
Mailing Address - Fax:302-623-7505
Practice Address - Street 1:4512 KIRKWOOD HWY STE 300
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5129
Practice Address - Country:US
Practice Address - Phone:302-623-7500
Practice Address - Fax:302-623-7505
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-22
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0013229363LF0000X, 363L00000X
DEL1-0047657163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner