Provider Demographics
NPI:1649961863
Name:GURLEY, KIMBERLEY (FNP-C)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:
Last Name:GURLEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278A GEIGER RD
Mailing Address - Street 2:
Mailing Address - City:LUCEDALE
Mailing Address - State:MS
Mailing Address - Zip Code:39452-8718
Mailing Address - Country:US
Mailing Address - Phone:251-709-9736
Mailing Address - Fax:
Practice Address - Street 1:22689 MS-63
Practice Address - Street 2:
Practice Address - City:LEAKESVILLE
Practice Address - State:MS
Practice Address - Zip Code:39451
Practice Address - Country:US
Practice Address - Phone:601-394-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905981363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner