Healthcare Provider Details

I. General information

NPI: 1003573551
Provider Name (Legal Business Name): REGINA CROWDER-GALLOWAY MBA/MSW, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SCHOOL CIR
HARRISBURG NC
28075-9610
US

IV. Provider business mailing address

PO BOX 865
HARRISBURG NC
28075-0865
US

V. Phone/Fax

Practice location:
  • Phone: 704-455-1762
  • Fax: 704-455-1760
Mailing address:
  • Phone: 704-455-1764
  • Fax: 704-455-1760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5017401
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC013881
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number297482
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: