Healthcare Provider Details

I. General information

NPI: 1093900276
Provider Name (Legal Business Name): COURTNEY ANNE GOUGE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 BROOKFORD BLVD
HICKORY NC
28602-9180
US

IV. Provider business mailing address

PO BOX 829
HILDEBRAN NC
28637-0829
US

V. Phone/Fax

Practice location:
  • Phone: 828-330-2103
  • Fax: 828-294-0131
Mailing address:
  • Phone: 828-397-3522
  • Fax: 828-397-5271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-01242
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110002616
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: