Provider Demographics
NPI:1871069724
Name:GALLEGLY, TEISHA ALYNN (FNP-C, AGAC-BC)
Entity type:Individual
Prefix:MRS
First Name:TEISHA
Middle Name:ALYNN
Last Name:GALLEGLY
Suffix:
Gender:F
Credentials:FNP-C, AGAC-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 NW 144TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-1573
Mailing Address - Country:US
Mailing Address - Phone:405-623-0777
Mailing Address - Fax:
Practice Address - Street 1:507 NE 12TH ST
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5807
Practice Address - Country:US
Practice Address - Phone:405-623-0777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-18
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0092903363L00000X
OK92903207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine