Healthcare Provider Details

I. General information

NPI: 1831506922
Provider Name (Legal Business Name): KIMBERLI JO GALLOWAY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2014
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 S DESERT VIEW DR
CORNVILLE AZ
86325-4999
US

IV. Provider business mailing address

965 S DESERT VIEW DR
CORNVILLE AZ
86325-4999
US

V. Phone/Fax

Practice location:
  • Phone: 760-271-3603
  • Fax:
Mailing address:
  • Phone: 760-271-3603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number342002
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28201347A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number803891
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN171759
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: