Provider Demographics
NPI:1194333781
Name:GALLIMORE, BECKY (NP)
Entity type:Individual
Prefix:
First Name:BECKY
Middle Name:
Last Name:GALLIMORE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:
Other - Last Name:MICHEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:562 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-6942
Mailing Address - Country:US
Mailing Address - Phone:508-761-5650
Mailing Address - Fax:508-761-9870
Practice Address - Street 1:562 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SOUTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-6942
Practice Address - Country:US
Practice Address - Phone:508-761-5650
Practice Address - Fax:508-761-9870
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN280568363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care