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General NPI Number Information
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NPI Number | 1013529791
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Entity Type | Individual
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Provider Name | FABIAN GILBERT GALLEGOS MSN, APRN, AGACNP-BC
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Gender | Male
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Dates
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Enumeration Date | 08/23/2020
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Last Update Date | 10/11/2021
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Provider Practice Location Address
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Address Line | 1201 HEALTH CENTER PKWY
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City | YUKON
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State | OK
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Zip | 73099-6381
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Country | US
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Telephone | 888-611-4429
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Fax |
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Provider Business Mailing Address
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Address Line | 9813 SW 27TH ST
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City | YUKON
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State | OK
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Zip | 73099-6977
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Country | US
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Telephone | 405-473-2263
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 106503
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R0106503
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License Number State | OK
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