Provider Demographics
NPI:1225094519
Name:GULLEY, CATHERINE (PA)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:GULLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 OSBOURNE WAY
Mailing Address - Street 2:ST 101
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-8004
Mailing Address - Country:US
Mailing Address - Phone:502-570-0007
Mailing Address - Fax:502-570-0500
Practice Address - Street 1:111 OSBOURNE WAY
Practice Address - Street 2:ST 101
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-8004
Practice Address - Country:US
Practice Address - Phone:502-570-0007
Practice Address - Fax:502-570-0500
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA208363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0404722Medicare PIN
R79078Medicare UPIN