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General NPI Number Information
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NPI Number | 1285171694
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Entity Type | Individual
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Provider Name | STACY GAILLARD
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Gender | Female
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Dates
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Enumeration Date | 01/23/2017
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Last Update Date | 06/28/2023
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Provider Practice Location Address
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Address Line | 109 W MAIN ST
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City | MONCKS CORNER
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State | SC
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Zip | 29461-2673
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Country | US
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Telephone | 843-719-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 411 FARMERS MARKET RD
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City | SAINT GEORGE
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State | SC
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Zip | 29477-8290
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Country | US
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Telephone |
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 20150
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 20150
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number | 20150
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License Number State | SC
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