Provider Demographics
NPI:1194946426
Name:GALLAHER, KATINA NICOLE (RN)
Entity type:Individual
Prefix:
First Name:KATINA
Middle Name:NICOLE
Last Name:GALLAHER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 HILLCREST CIR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TN
Mailing Address - Zip Code:37322-7965
Mailing Address - Country:US
Mailing Address - Phone:423-834-2087
Mailing Address - Fax:
Practice Address - Street 1:389 RIVER RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TN
Practice Address - Zip Code:37322-7801
Practice Address - Country:US
Practice Address - Phone:423-334-5185
Practice Address - Fax:423-334-1713
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000150460163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health