Provider Demographics
NPI:1043767874
Name:GALLO, KELLY (WHNP-BC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:GALLO
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 CREEKSIDE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-1954
Mailing Address - Country:US
Mailing Address - Phone:239-513-1992
Mailing Address - Fax:239-513-9022
Practice Address - Street 1:1265 CREEKSIDE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-1954
Practice Address - Country:US
Practice Address - Phone:239-513-1992
Practice Address - Fax:239-513-9022
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-09
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173939363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health