Provider Demographics
NPI:1346832854
Name:GULLEY, PHILLIP (NP)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:
Last Name:GULLEY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5441 BABCOCK RD STE 301
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-3993
Mailing Address - Country:US
Mailing Address - Phone:210-641-1394
Mailing Address - Fax:210-561-2846
Practice Address - Street 1:5441 BABCOCK RD STE 301
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-3993
Practice Address - Country:US
Practice Address - Phone:210-641-1394
Practice Address - Fax:210-561-2846
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1029830363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care