Healthcare Provider Details

I. General information

NPI: 1336165356
Provider Name (Legal Business Name): KRISTIN M GALLOP NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date: 10/11/2023
Reactivation Date: 10/20/2023

III. Provider practice location address

59 BANGOR ST
HOULTON ME
04730-1740
US

IV. Provider business mailing address

529 S PATTEN RD
PATTEN ME
04765-3007
US

V. Phone/Fax

Practice location:
  • Phone: 207-538-3700
  • Fax:
Mailing address:
  • Phone: 207-538-3700
  • Fax: 207-528-2880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCNP231493
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberCNP231493
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberCNP231493
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: