Healthcare Provider Details

I. General information

NPI: 1952645087
Provider Name (Legal Business Name): CAROLYN LEIGH GALLAGHER CNM, APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 BELLEVUE AVE STE 400
SAINT LOUIS MO
63117-1858
US

IV. Provider business mailing address

6420 CLAYTON RD SUITE 290
SAINT LOUIS MO
63117-1811
US

V. Phone/Fax

Practice location:
  • Phone: 314-977-7455
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number11132674
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number2015026430
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: