NPIMap

Individual provider Active NPI

Jennifer Leigh Galle, NP-C

  • Nurse Practitioner
  • Gulfport, MS
National Provider Identifier
1073747564
Registry record updated Apr 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
R864186 Issued in MS
Practice address
9471 Three Rivers Rd Ste D
Gulfport, MS 39503-4230
Phone
(228) 248-0058
Fax
(228) 248-0129
NPI assigned
May 12, 2009
Last updated
Apr 12, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X R864186 MS Primary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 864186 MS

Addresses

Primary practice location

9471 Three Rivers Rd Ste D
Gulfport, MS 39503-4230

Mailing address

250 Beauvoir Rd Ste 4B
Biloxi, MS 39531-4026
Phone (228) 388-9848

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200507002858 MS Practitioner - Nurse Practitioner 9234560293 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2008
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

993 Tommy Munro Dr
Suite C
Biloxi, MS 39532-2178
Phone (228) 382-3140

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R864186MSMDNurse Practitioner
864186MSMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Bloom Mental Health LLC Psychiatric/Mental Health CurrentSince Jan 1, 2021 Accepting new patients
Palladium Hospice and Palliative Care, LLC CurrentSince Jul 24, 2022 Accepting new patients
Primesource Nursing Services, Inc Psychiatric/Mental Health CurrentSince May 1, 2020 Accepting new patients
Primesource Nursing Services, Inc CurrentSince May 1, 2020 Accepting new patients

Locations

993 Tommy Munro Dr
Ste C
Biloxi, MS 39532
Phone (228) 207-0390

370 Courthouse Rd
Ste 106
Gulfport, MS 39507

Organizations & group practices 4

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.

Hospital & facility affiliations 60

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 60

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1242086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618185600000",
    "number": "1073747564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 BEAUVOIR RD STE 4B",
            "city": "BILOXI",
            "state": "MS",
            "postal_code": "395314026",
            "telephone_number": "228-388-9848",
            "fax_number": "228-388-4157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9471 THREE RIVERS RD STE D",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395034230",
            "telephone_number": "228-248-0058",
            "fax_number": "228-248-0129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALLE",
        "first_name": "JENNIFER",
        "middle_name": "LEIGH",
        "name_prefix": "Ms.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-12",
        "last_updated": "2021-04-12",
        "certification_date": "2021-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "R864186",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MS",
            "license": "864186",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulfport, MS

Sources for this page

Verify at the official NPI Registry.