TERRY LEE GOURLEY PA NPI 1710014477

NPI Information

NPI: 1710014477
Provider Name: TERRY LEE GOURLEY, PA
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

PECOS Registration: Yes

Address:
2900 DOOLITTLE DR
ELLSWORTH AFB, SD
ZIP 57706
Phone: (053) 853-2736
Get Directions

Terry Lee Gourley, PA is a medical physician assistant in Ellsworth Afb, SD. Terry Lee Gourley, PA NPI is 1710014477. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2900 DOOLITTLE DR
ELLSWORTH AFB, SD
ZIP 57706-821
Phone: (053) 853-2736
Fax: (308) 367-4164

The NPI 1710014477 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 2/28/2007 and was last updated on 5/3/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AM0700X	Physician Assistant	Medical	866	NEBRASKA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1029358	OTHER	SOUTH DAKOTA	NCCPA CERT
2	866	OTHER	NEBRASKA	LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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