=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215169305
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMIE ORTOSKY GALLAGHER FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2009
-----------------------------------------------------
Last Update Date | 11/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 817 BUCKNER CT
-----------------------------------------------------
City | FUQUAY VARINA
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27526-2806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-520-1438
-----------------------------------------------------
Fax | 888-225-1886
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1441 E BROAD ST STE 121
-----------------------------------------------------
City | FUQUAY VARINA
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27526-1968
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-520-1438
-----------------------------------------------------
Fax | 888-225-1886
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 5004470
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------