Healthcare Provider Details

I. General information

NPI: 1780366138
Provider Name (Legal Business Name): BREANNA EMILY GALLAGHER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2023
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 TIGER BLVD
CLEMSON SC
29631-1114
US

IV. Provider business mailing address

1300 TIGER BLVD
CLEMSON SC
29631-1114
US

V. Phone/Fax

Practice location:
  • Phone: 864-653-6724
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number27714
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5023899
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: