Healthcare Provider Details

I. General information

NPI: 1902308950
Provider Name (Legal Business Name): SKYLER ANTHONY GALLAWAY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E 2ND ST
LIBBY MT
59923-2010
US

IV. Provider business mailing address

8310 W DESCHUTES AVE
KENNEWICK WA
99336-1629
US

V. Phone/Fax

Practice location:
  • Phone: 406-283-6900
  • Fax:
Mailing address:
  • Phone: 509-989-0624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: