Provider Demographics
NPI:1487373148
Name:GALLOP, STACY (FNP-BC)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:GALLOP
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 CONVALESCENT RD
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:AL
Mailing Address - Zip Code:35592-4823
Mailing Address - Country:US
Mailing Address - Phone:205-695-9313
Mailing Address - Fax:205-695-9820
Practice Address - Street 1:1050 CONVALESCENT RD
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:AL
Practice Address - Zip Code:35592-4823
Practice Address - Country:US
Practice Address - Phone:205-431-3006
Practice Address - Fax:205-695-9820
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-122001363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily