Provider Demographics
NPI:1194392290
Name:GALLOWAY, CORTNEY SHAYVON (NP)
Entity type:Individual
Prefix:MS
First Name:CORTNEY
Middle Name:SHAYVON
Last Name:GALLOWAY
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4049 WEYANOKE DR
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-2027
Mailing Address - Country:US
Mailing Address - Phone:757-724-1651
Mailing Address - Fax:
Practice Address - Street 1:4049 WEYANOKE DR
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-2027
Practice Address - Country:US
Practice Address - Phone:757-724-1651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001265365363LF0000X
VA0024181586363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily