Stacian Gallimore-King, NP
Nurse Practitioner, Family in Bronx, NY. Individual provider (NPI-1).
NPI number1164090767
StatusActive
Last updated in NPPESOct 18, 2021
Details
- NPI
- 1164090767
- Entity type
- Individual (NPI-1)
- Name
- Stacian Gallimore-King
- Credential
- NP
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jun 11, 2021
- Certification date
- Oct 18, 2021
- Last updated
- Oct 18, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 0516845 | NY | Yes |
Practice location
1695 Eastchester RdBronx, NY 10461-2374
Phone 718-405-8505
Mailing address
3044 Ely AveBronx, NY 10469-3227
Phone 718-924-1601
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