Provider Demographics
NPI:1568855716
Name:GURLEY, REGINA (PA-C)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:GURLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:E
Other - Last Name:GURLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2000 PERIMETER PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:208 COX BLVD STE 100
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9414
Practice Address - Country:US
Practice Address - Phone:919-587-4051
Practice Address - Fax:919-580-1083
Is Sole Proprietor?:No
Enumeration Date:2015-03-12
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05639363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant