Provider Demographics
NPI:1326016486
Name:HARKNESS, GALE LYNN (MPH PHD PAC)
Entity Type:Individual
Prefix:MR
First Name:GALE
Middle Name:LYNN
Last Name:HARKNESS
Suffix:
Gender:M
Credentials:MPH PHD PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 PEBBLEBROOK RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-9619
Mailing Address - Country:US
Mailing Address - Phone:336-377-9170
Mailing Address - Fax:
Practice Address - Street 1:1009 MAIN ST
Practice Address - Street 2:STOKES FAMILY HEALTH CENTER
Practice Address - City:DANBURY
Practice Address - State:NC
Practice Address - Zip Code:27016-0187
Practice Address - Country:US
Practice Address - Phone:336-593-2400
Practice Address - Fax:336-593-9361
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100127363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC100127OtherNC LIC #
NCMH012566ZOtherDEA
S85374Medicare UPIN
NC100127OtherNC LIC #