Provider Demographics
NPI:1306184338
Name:GALLEGOS, KATIE ANN (FNP-C)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:ANN
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:ANN
Other - Last Name:MORRISSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:5080 SPECTRUM DR.
Mailing Address - Street 2:1100E
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001
Mailing Address - Country:US
Mailing Address - Phone:844-934-2333
Mailing Address - Fax:817-299-1706
Practice Address - Street 1:5080 SPECTRUM DR.
Practice Address - Street 2:1100E
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001
Practice Address - Country:US
Practice Address - Phone:844-934-2333
Practice Address - Fax:817-299-1706
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-25
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134328363LF0000X
TX750773163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant