Mary Jane Gallahan, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA2003-0025 Issued in NM

Practice address

622 W Maple
Suite B
Farmington, NM 87401

Phone

(505) 327-4867

Fax

(505) 327-5355

NPI assigned

Jul 7, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: mgallahan8076@ahs.direct-ci.com

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462838400000",
    "number": "1952308694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4901 LANG AVE NE",
            "address_2": "SUITE 100",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871094495",
            "telephone_number": "505-883-2574",
            "fax_number": "505-265-4033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 W MAPLE",
            "address_2": "SUITE B",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "87401",
            "telephone_number": "505-327-4867",
            "fax_number": "505-327-5355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALLAHAN",
        "first_name": "MARY",
        "middle_name": "JANE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-07",
        "last_updated": "2016-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NM",
            "license": "PA2003-0025",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MCRE PTAN",
            "identifier": "P00446751",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89374878",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "56576",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kellie L. Fuller, CMT,LMT
• James E. Fundark, LPCC
• G & G Medical Inc
• Jude Gabaldon, M.D.
• Rebecca J. Gale, LCSW
• April Gallegos, LSAA
• Matt Gallegos, CPSW
• Stephanie Garcia Erives
• Alejandrina Garcia, SCHOOL PSYCHOLOGIST
• Annalee Diandra Garcia

• Physician Assistant in Farmington, NM
• Providers in Farmington, NM by specialty
• Physician Assistant in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.