Healthcare Provider Details

I. General information

NPI: 1558022616
Provider Name (Legal Business Name): TREY GALLOWAY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2021
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 W PIERCE ST
CARLSBAD NM
88220-3553
US

IV. Provider business mailing address

172 TIDEWATER RD
HATTIESBURG MS
39402-7923
US

V. Phone/Fax

Practice location:
  • Phone: 660-826-5960
  • Fax:
Mailing address:
  • Phone: 469-569-5065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1130355
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number911910-30
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number66477
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: