Provider Demographics
NPI:1396219564
Name:GALLEGOS, BRITTANY LYNN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:LYNN
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4403 HARRISON BLVD STE 3450
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-3282
Mailing Address - Country:US
Mailing Address - Phone:801-387-3850
Mailing Address - Fax:
Practice Address - Street 1:4403 HARRISON BLVD STE 3450
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3282
Practice Address - Country:US
Practice Address - Phone:801-387-3850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-21
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7895297-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant