Healthcare Provider Details

I. General information

NPI: 1821526559
Provider Name (Legal Business Name): PAIGE JEAN GALLAS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAIGE JEAN BAECHLE PA-C

II. Dates (important events)

Enumeration Date: 05/25/2017
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 FALCON DR STE 104
MT STERLING KY
40353-9792
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 859-497-5160
  • Fax: 859-497-5166
Mailing address:
  • Phone:
  • Fax: 606-330-7825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2224
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2224
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA2224
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: