Provider Demographics
NPI:1790971224
Name:GAINES, SALLY LYNN (MSN, RN)
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:LYNN
Last Name:GAINES
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WEST TEXAS A & M UNIVERSITY
Mailing Address - Street 2:OLD MAIN, ROOM 308-A
Mailing Address - City:CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79016-0001
Mailing Address - Country:US
Mailing Address - Phone:806-651-2648
Mailing Address - Fax:806-651-2632
Practice Address - Street 1:WEST TEXAS A & M UNIVERSITY
Practice Address - Street 2:OLD MAIN, ROOM 308-A
Practice Address - City:CANYON
Practice Address - State:TX
Practice Address - Zip Code:79016-0001
Practice Address - Country:US
Practice Address - Phone:806-651-2648
Practice Address - Fax:806-651-2632
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX658141390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program