Healthcare Provider Details

I. General information

NPI: 1578762167
Provider Name (Legal Business Name): JAYNE GALLAGHER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 GRAYS HWY
RIDGELAND SC
29936
US

IV. Provider business mailing address

1050 RIBAUT RD
BEAUFORT SC
29902-5400
US

V. Phone/Fax

Practice location:
  • Phone: 843-726-8030
  • Fax:
Mailing address:
  • Phone: 843-524-8899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number3129
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: