Provider Demographics
NPI:1124434204
Name:SHOLEY, GAYLA
Entity type:Individual
Prefix:MRS
First Name:GAYLA
Middle Name:
Last Name:SHOLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GAYLA
Other - Middle Name:
Other - Last Name:MCKNIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, CNM
Mailing Address - Street 1:2751 BAY PARK DRIVE
Mailing Address - Street 2:#300
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616
Mailing Address - Country:US
Mailing Address - Phone:419-690-7596
Mailing Address - Fax:419-697-6707
Practice Address - Street 1:141 N EAGLE CREEK DR STE 200
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2538
Practice Address - Country:US
Practice Address - Phone:859-323-9897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH367A00000X
KY00000367A00000X
KY56331367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0197005Medicaid
OHH558270OtherOHIO MEDICARE