Healthcare Provider Details

I. General information

NPI: 1255253894
Provider Name (Legal Business Name): KRISTINA MARIE GALL BSN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 CENTURY PKWY
NEODESHA KS
66757-1295
US

IV. Provider business mailing address

38 CENTURY PKWY
NEODESHA KS
66757-1295
US

V. Phone/Fax

Practice location:
  • Phone: 785-207-0771
  • Fax:
Mailing address:
  • Phone: 785-207-0771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number13-159047-112
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: