MEDICARE: TAYLOR ANN GALLIK

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	390200000X	Student in an Organized Health Care Education/Training Program		VA

General Provider Information

NPI Number	:	1720947351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR ANN GALLIK

Provider Business Mailing Address
First Line	:	4163 RAINEY WOODS DR
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38125-3170
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4163 RAINEY WOODS DR
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38125-3170
Country	:	US
Telephone Number	:	901-624-7639
Fax Number	:

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

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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