Provider Demographics
NPI:1528273943
Name:GALLARDO, KATHY A (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:KATHY
Middle Name:A
Last Name:GALLARDO
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 GLACIER AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-1567
Mailing Address - Country:US
Mailing Address - Phone:907-600-1734
Mailing Address - Fax:907-600-1640
Practice Address - Street 1:1200 GLACIER AVE STE 103
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1567
Practice Address - Country:US
Practice Address - Phone:907-600-1734
Practice Address - Fax:907-600-1640
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1862752084P0804X, 2084P0800X
VA01012363402084P0804X
MDD617382084P0804X
CAA986362084P0804X
DCMD0348922084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry