Active NPI
Raelynn Benally
- Family Nurse Practitioner
- Gallup, NM
National Provider Identifier
1053855593
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 85128
- Practice address
- 2111 College Dr
Gallup, NM 87301-5600 - Phone
- (505) 397-5172
- Fax
- (877) 396-1184
- NPI assigned
- Dec 16, 2016
- Last updated
- Jan 28, 2026
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 85128 | NM | Primary |
| Registered Nurse | 163W00000X | RN-75921 | NM |
Addresses
Primary practice location
2111 College Dr
Gallup, NM 87301-5600
Mailing address
2111 College Dr
Gallup, NM 87301-5600
Phone (505) 397-5172
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| N0011073 | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN-75921 | NM | MD | Registered Nurse |
| 85128 | NM | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gallup Community Health | Single Specialty | Past | Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/FBBICD
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Federally Qualified Health Center (FQHC)
- Gallup, NM
- NPI 1336807254
Single Specialty
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1481846400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1769558400000",
"number": "1053855593",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2111 COLLEGE DR",
"city": "GALLUP",
"state": "NM",
"postal_code": "873015600",
"telephone_number": "505-397-5172",
"fax_number": "877-396-1184"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2111 COLLEGE DR",
"city": "GALLUP",
"state": "NM",
"postal_code": "873015600",
"telephone_number": "505-397-5172",
"fax_number": "877-396-1184"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENALLY",
"first_name": "RAELYNN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-12-16",
"last_updated": "2026-01-28",
"certification_date": "2026-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "NM",
"license": "85128",
"primary": true
},
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "NM",
"license": "RN-75921",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "N0011073",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gallup, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.