Provider Demographics
NPI:1093173643
Name:GALLOWAY, RAYMOND FORREST JR (APRN)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:FORREST
Last Name:GALLOWAY
Suffix:JR
Gender:M
Credentials:APRN
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Mailing Address - Street 1:9101 KANIS RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205
Mailing Address - Country:US
Mailing Address - Phone:501-224-4001
Mailing Address - Fax:504-224-4003
Practice Address - Street 1:9101 KANIS RD
Practice Address - Street 2:SUITE 400
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205
Practice Address - Country:US
Practice Address - Phone:501-224-4001
Practice Address - Fax:504-224-4003
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
ARA004607363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARA004607Medicaid