Provider Demographics
NPI:1700284486
Name:GOURLEY, CHERYL (PA-C)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:GOURLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 MORRO ST
Mailing Address - Street 2:APT 4R
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4065
Mailing Address - Country:US
Mailing Address - Phone:505-850-3031
Mailing Address - Fax:
Practice Address - Street 1:211 E 2ND ST
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923-2047
Practice Address - Country:US
Practice Address - Phone:406-293-8711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-12
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant