person
Terry Lee Gourley, PA
Medical Physician Assistant in Ellsworth Afb, South Dakota
NPI 1710014477

Terry Lee Gourley is a Medical Physician Assistant based in Ellsworth Afb, SD and is specialized in Medical. Terry Lee Gourley practices in Ellsworth Afb, SD and has the professional credentials of PA. The NPI Number for Terry Lee Gourley is 1710014477 and holds a License No. 866 (South Dakota).

The current practice location address for Terry Lee Gourley is 2900 Doolittle Dr, Ellsworth Afb, SD and can be reached out via phone at 053-853-2736 and via fax at 308-367-4164. You can also correspond with Terry Lee Gourley through the mailing address at 2900 DOOLITTLE DR, ELLSWORTH AFB, SD - 57706-4821 (mailing address contact number: 605-385-3111).

Location: 2900 Doolittle Dr, Ellsworth Afb, SD, 57706-4821
person
Provider Profile Details
NPI Number
1710014477
Provider Name
Terry Lee Gourley
Credential
PA
Provider Entity Type
Individual
Gender
Male
Address
2900 Doolittle Dr, Ellsworth Afb, SD, 57706-4821
Phone Number
053-853-2736
Fax Number
308-367-4164
Provider Enumeration Date
02/28/2007
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
866 01 NE LICENSE
1029358 01 SD NCCPA CERT
institution
Provider Business Practice Location Address Details
Address
2900 Doolittle Dr
City
State
Zip
57706-4821
Phone Number
053-853-2736
Fax Number
308-367-4164
person
Provider Business Mailing Address Details
Address
2900 Doolittle Dr
City
State
Zip
57706-4821
Phone Number
053-853-2736
Fax Number
308-367-4164
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Medical
Taxonomy
License No.
866 (Nebraska)
Definition
Definition to come...
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