Healthcare Provider Details

I. General information

NPI: 1033814785
Provider Name (Legal Business Name): ELIZABETH ASHLEY GALLAWAY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 W 6TH AVE
STILLWATER OK
74074-4399
US

IV. Provider business mailing address

403 E NOBLE RD
STILLWATER OK
74075-1952
US

V. Phone/Fax

Practice location:
  • Phone: 405-372-1480
  • Fax:
Mailing address:
  • Phone: 405-614-3120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR0113948
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number212142
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number212142
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: