Healthcare Provider Details

I. General information

NPI: 1285503276
Provider Name (Legal Business Name): KIMBERLY GALLAGHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2025
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 SE OCEAN BLVD
STUART FL
34994-2471
US

IV. Provider business mailing address

2434 OAK DR
HUTCHINSON ISLAND FL
34949-1535
US

V. Phone/Fax

Practice location:
  • Phone: 772-419-0505
  • Fax: 800-419-1224
Mailing address:
  • Phone: 732-232-1873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN11043140
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: