Provider Demographics
NPI:1235173220
Name:GALE, STEPHANIE MCLAIN (APRN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MCLAIN
Last Name:GALE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:LORRAINE
Other - Last Name:MCLAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:350 N HUMPHREYS BLVD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2177
Mailing Address - Country:US
Mailing Address - Phone:901-226-4003
Mailing Address - Fax:901-227-8591
Practice Address - Street 1:3700 N FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39701-8408
Practice Address - Country:US
Practice Address - Phone:662-240-9999
Practice Address - Fax:662-241-5451
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS825609363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00119235Medicaid
MS562251777OtherBLUE CROSS