MEDICARE: DR. SHAWN PATRICK GALLAGHER PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN206577	AZ
2	363LF0000X	Family Nurse Practitioner	AP9999	AZ
3	363LF0000X	Family Nurse Practitioner	8879	WI
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	8879	WI
5	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP9995	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710903281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAWN PATRICK GALLAGHER PMHNP-BC

Provider Business Mailing Address
First Line	:	2587 N BEVERLY PL
Second Line	:
City	:	BUCKEYE
State	:	AZ
Zip	:	85396-1793
Country	:	US
Telephone Number	:	210-380-2107
Fax Number	:

Provider Business Practice Location Address
First Line	:	2587 N BEVERLY PL
Second Line	:
City	:	BUCKEYE
State	:	AZ
Zip	:	85396-1793
Country	:	US
Telephone Number	:	210-380-2107
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	05/20/2022

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Directions to “ DR. SHAWN PATRICK GALLAGHER PMHNP-BC” Practice Location

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