Provider Demographics
NPI:1710925458
Name:GALLAGHER, JOANNE M (NP)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:M
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6170 SHALLOWFORD RD
Mailing Address - Street 2:101
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-1892
Mailing Address - Country:US
Mailing Address - Phone:423-648-4500
Mailing Address - Fax:423-855-7563
Practice Address - Street 1:2021 HAMILTON PLACE BLVD
Practice Address - Street 2:G
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-6046
Practice Address - Country:US
Practice Address - Phone:423-899-6222
Practice Address - Fax:423-499-0294
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNRN0000123113363L00000X
TNAPN7853363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P35468Medicare UPIN
TN1016710001Medicare NSC
3904198Medicare ID - Type Unspecified