Provider Demographics
NPI:1568638112
Name:GALLEMORE, KAREN SUE (NP)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:SUE
Last Name:GALLEMORE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 818
Mailing Address - Street 2:
Mailing Address - City:NEOSHO
Mailing Address - State:MO
Mailing Address - Zip Code:64850-0818
Mailing Address - Country:US
Mailing Address - Phone:417-455-2883
Mailing Address - Fax:417-455-9358
Practice Address - Street 1:1504 N BUSINESS 71
Practice Address - Street 2:
Practice Address - City:NEOSHO
Practice Address - State:MO
Practice Address - Zip Code:64850-1975
Practice Address - Country:US
Practice Address - Phone:417-455-2883
Practice Address - Fax:417-455-9358
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO084393363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420014300Medicaid