Provider Demographics
NPI:1114476769
Name:GALLAGHER, BRANDY LEIGH (NP)
Entity Type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:LEIGH
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:BRANDY
Other - Middle Name:LEIGH
Other - Last Name:BARHAM-SCHERER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1241 HORNBLEND ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-2947
Mailing Address - Country:US
Mailing Address - Phone:720-231-4713
Mailing Address - Fax:
Practice Address - Street 1:9850 GENESEE AVE STE 440
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1212
Practice Address - Country:US
Practice Address - Phone:858-453-5944
Practice Address - Fax:858-429-7925
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95004515363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA193400000XOtherSINGLE FAMILY NURSE PRACTITIONER