Provider Demographics
NPI:1023375060
Name:GALLAHORN, AIMEE PATRICIA (CHAIII)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:PATRICIA
Last Name:GALLAHORN
Suffix:
Gender:F
Credentials:CHAIII
Other - Prefix:
Other - First Name:AIMEE
Other - Middle Name:PATRICIA
Other - Last Name:DAVENPORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CHAIII
Mailing Address - Street 1:PO BOX 49
Mailing Address - Street 2:
Mailing Address - City:POINT HOPE
Mailing Address - State:AK
Mailing Address - Zip Code:99766-0049
Mailing Address - Country:US
Mailing Address - Phone:907-368-2234
Mailing Address - Fax:907-368-2569
Practice Address - Street 1:1749 QUALAGI AVE.
Practice Address - Street 2:
Practice Address - City:POINT HOPE
Practice Address - State:AK
Practice Address - Zip Code:99766
Practice Address - Country:US
Practice Address - Phone:907-368-2234
Practice Address - Fax:907-368-2569
Is Sole Proprietor?:No
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK10-1055-III172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker