Provider Demographics
NPI:1861227399
Name:TURLEY, GWINIVERE
Entity type:Individual
Prefix:
First Name:GWINIVERE
Middle Name:
Last Name:TURLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 W HEBRON PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-6342
Mailing Address - Country:US
Mailing Address - Phone:972-426-8675
Mailing Address - Fax:972-492-4694
Practice Address - Street 1:1601 W HEBRON PKWY STE 100
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-6342
Practice Address - Country:US
Practice Address - Phone:972-426-8675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA19324363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant