Provider Demographics
NPI:1164406773
Name:VARNELL, GAYLE PEGLER (PHD, RN, PNP)
Entity Type:Individual
Prefix:DR
First Name:GAYLE
Middle Name:PEGLER
Last Name:VARNELL
Suffix:
Gender:F
Credentials:PHD, RN, PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19970 HOLLY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:LARUE
Mailing Address - State:TX
Mailing Address - Zip Code:75770-6306
Mailing Address - Country:US
Mailing Address - Phone:903-849-2329
Mailing Address - Fax:
Practice Address - Street 1:3900 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75799-0001
Practice Address - Country:US
Practice Address - Phone:903-566-7035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225095363L00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149252202Medicaid
TX149252202Medicaid
TX8B4867Medicare ID - Type Unspecified