Provider Demographics
NPI:1053165720
Name:GALLOWAY, JILL CHRISTINE
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:CHRISTINE
Last Name:GALLOWAY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:CHRISTINE
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:405 E EXCELSIOR AVE
Mailing Address - Street 2:
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301-4226
Mailing Address - Country:US
Mailing Address - Phone:918-256-6476
Mailing Address - Fax:918-256-3628
Practice Address - Street 1:405 E EXCELSIOR AVE
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-4226
Practice Address - Country:US
Practice Address - Phone:918-256-6476
Practice Address - Fax:918-256-3628
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OK175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator