MEDICARE: REID GOURLEY RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0807X	Child & Adolescent Psychiatric/Mental Health Registered Nurse	065551-21	NH
2	163WP0808X	Psychiatric/Mental Health Registered Nurse	065551-21	NH
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	065551-23	NH

General Provider Information

NPI Number	:	1972365781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REID GOURLEY RN

Provider Business Mailing Address
First Line	:	107 SERENITAS LN
Second Line	:
City	:	GOFFSTOWN
State	:	NH
Zip	:	03045-2922
Country	:	US
Telephone Number	:	603-860-9657
Fax Number	:

Provider Business Practice Location Address
First Line	:	218 EAST RD
Second Line	:
City	:	HAMPSTEAD
State	:	NH
Zip	:	03841-5303
Country	:	US
Telephone Number	:	603-329-5311
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2024
Last Update Date	:	04/15/2025

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