Provider Demographics
NPI:1134883721
Name:GALLIMORE, KIERSTON (MEDICAL ASSISTANT)
Entity type:Individual
Prefix:
First Name:KIERSTON
Middle Name:
Last Name:GALLIMORE
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6742 15TH AVE LOWR UNIT
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-4946
Mailing Address - Country:US
Mailing Address - Phone:847-708-9671
Mailing Address - Fax:
Practice Address - Street 1:6742 15TH AVE LOWR UNIT
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-4946
Practice Address - Country:US
Practice Address - Phone:847-708-9671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-28
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No374J00000XNursing Service Related ProvidersDoula