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General NPI Number Information
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NPI Number | 1871515866
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Entity Type | Individual
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Provider Name | BETH GURLEY PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 2515 LEWISVILLE CLEMMONS RD
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City | CLEMMONS
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State | NC
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Zip | 27012-8712
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Country | US
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Telephone | 336-979-4499
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Fax | 336-355-7505
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Provider Business Mailing Address
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Address Line | 765 HIGHLAND OAKS DR SUITE 100
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City | WINSTON SALEM
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State | NC
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Zip | 27103-7101
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Country | US
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Telephone | 336-760-4004
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Fax | 336-760-6632
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 103453
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License Number State | NC
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