Provider Demographics
NPI:1740787795
Name:GALLETTA, KALEENA (FNP-C)
Entity Type:Individual
Prefix:
First Name:KALEENA
Middle Name:
Last Name:GALLETTA
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 1:348 RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:COTTAGE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:62018-1238
Mailing Address - Country:US
Mailing Address - Phone:618-978-7897
Mailing Address - Fax:
Practice Address - Street 1:4273 S., IL - 159
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034
Practice Address - Country:US
Practice Address - Phone:618-288-2297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-06
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018010583363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily