MEDICARE: JESSICA RAYE GALLIMORE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	5012884	NC
2	363LA2100X	Acute Care Nurse Practitioner	5012884	NC
3	363L00000X	Nurse Practitioner	5012884	NC

General Provider Information

NPI Number	:	1497388490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA RAYE GALLIMORE NP

Provider Business Mailing Address
First Line	:	PO BOX 19305
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28219-9305
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1350 S KINGS DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28207-2134
Country	:	US
Telephone Number	:	704-446-1255
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2020
Last Update Date	:	04/17/2026

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