Provider Demographics
NPI:1144563073
Name:GURLEY, KATHERINE A (APRN)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:A
Last Name:GURLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 910
Mailing Address - Street 2:
Mailing Address - City:MANILA
Mailing Address - State:AR
Mailing Address - Zip Code:72442-0910
Mailing Address - Country:US
Mailing Address - Phone:870-561-3300
Mailing Address - Fax:870-561-3307
Practice Address - Street 1:1001 N 6TH ST
Practice Address - Street 2:
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-1707
Practice Address - Country:US
Practice Address - Phone:870-281-2530
Practice Address - Fax:870-281-2532
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003841363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR200506758Medicaid