Provider Demographics
NPI:1548200942
Name:MCCORKLE, GAYLE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:GAYLE
Middle Name:
Last Name:MCCORKLE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46161 WESTLAKE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:POTOMAC FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:20165-5871
Mailing Address - Country:US
Mailing Address - Phone:703-433-9230
Mailing Address - Fax:703-433-9248
Practice Address - Street 1:46161 WESTLAKE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:POTOMAC FALLS
Practice Address - State:VA
Practice Address - Zip Code:20165-5871
Practice Address - Country:US
Practice Address - Phone:703-433-9230
Practice Address - Fax:703-433-9248
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024057267367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA000401N63Medicare PIN