Provider Demographics
NPI:1740093772
Name:GALLARDO, KATHIE M (MSN, APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KATHIE
Middle Name:M
Last Name:GALLARDO
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6812 RANDOL MILL RD LOT 8
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76120-1239
Mailing Address - Country:US
Mailing Address - Phone:817-807-1452
Mailing Address - Fax:
Practice Address - Street 1:906 W CANNON ST APT 100
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3052
Practice Address - Country:US
Practice Address - Phone:817-672-8602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1189833363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health