Provider Demographics
NPI:1588225387
Name:GALLOWAY, BRANDY (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 133
Mailing Address - Street 2:
Mailing Address - City:AYDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28513-0133
Mailing Address - Country:US
Mailing Address - Phone:252-651-5628
Mailing Address - Fax:252-290-6622
Practice Address - Street 1:463 SECOND ST
Practice Address - Street 2:
Practice Address - City:AYDEN
Practice Address - State:NC
Practice Address - Zip Code:28513-7179
Practice Address - Country:US
Practice Address - Phone:252-651-5628
Practice Address - Fax:252-290-6622
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011886363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5011886OtherNP LICENSE