Provider Demographics
NPI:1073747564
Name:GALLE, JENNIFER LEIGH (NP-C)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LEIGH
Last Name:GALLE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:250 BEAUVOIR RD STE 4B
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-4026
Mailing Address - Country:US
Mailing Address - Phone:228-388-9848
Mailing Address - Fax:228-388-4157
Practice Address - Street 1:9471 THREE RIVERS RD STE D
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-4230
Practice Address - Country:US
Practice Address - Phone:228-248-0058
Practice Address - Fax:228-248-0129
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS864186363LP0808X
MSR864186363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health