TERRY LEE GOURLEY (NPI# 1710014477) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710014477 |
| Entity Type | Individual |
| Full Name | TERRY LEE GOURLEY |
| Credential | PA |
| Practice Address |
2900 Doolittle Dr Ellsworth Afb SD 57706-4821 |
| Practice Telephone | 0538532736 |
| Practice Fax Number | 3083674164 |
| Mailing Telephone | 6053853111 |
| Mailing Fax Number | 6053853680 |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2018-05-03 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
866 | NE | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NE | LICENSE | 866 | 01 |
| SD | NCCPA CERT | 1029358 | 01 |
| Street Address |
2900 DOOLITTLE DR |
| City | ELLSWORTH AFB |
| State | SD |
| Zip Code | 57706-4821 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083607535 | Michael Scott Bogaard | Optometrist | 2900 Doolittle Dr, Ellsworth Afb, SD 57706-4821 | 2005-08-30 |
| 1023648128 | Sereirath Som Hart | Social Worker | 2900 Doolittle Dr, Ellsworth Afb, SD 57706-4821 | 2020-01-17 |
| 1811459662 | Anthony David Delcorral | Dentist | 2900 Doolittle Dr, Ellsworth Afb, SD 57706-4821 | 2019-04-02 |
| 1942766746 | Joseph Minette Stanfill | Social Worker | 2900 Doolittle Dr, Ellsworth Afb, SD 57706-4821 | 2019-02-16 |
| 1275016214 | Elizabeth Gunnell | Counselor | 2900 Doolittle Dr, Ellsworth Afb, SD 57706-4821 | 2018-09-14 |
| 1760989933 | Jeffrey Moran | Pharmacist | 2900 Doolittle Dr, Ellsworth Afb, SD 57706-4821 | 2018-04-12 |
| 1851898191 | Stephen Beals | Pharmacist | 2900 Doolittle Dr, Ellsworth Afb, SD 57706-4821 | 2018-04-12 |
| 1205330651 | Ariel Hough | Dentist | 2900 Doolittle Dr, Ellsworth Afb, SD 57706-4821 | 2018-03-21 |
| 1629576491 | Mario Luis Recupido IIi | Military Health Care Provider | 2900 Doolittle Dr, Ellsworth Afb, SD 57706 | 2018-01-26 |
| 1205342664 | Sheila Renee Johnson | Social Worker | 2900 Doolittle Dr, Ellsworth Afb, SD 57706-4821 | 2017-12-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801307202 | Patrick David Jones | Physician Assistant | 28th Mdg/sggp, 2900 Doolittle Dr., Ellsworth Afb, SD 57706 | 2017-10-12 |
| 1770736522 | Amy Marie Kubal | Dietitian, Registered | 2450 Risner Drive, Ellsworth Air Force Base Health and Wellness Center, Ellsworth Afb, SD 57706 | 2008-10-24 |
| 1275057754 | Adrianne Rae Littles | Military Health Care Provider | 2900 Doolittle Drive, Ellsworth Afb, SD 57706 | 2017-07-27 |
| 1467501874 | Tasha Dee Standing Soldier | Pharmacist | 2900 Doolittle Drive, 28th Medical Group, Ellsworth Afb, SD 57706 | 2007-01-09 |
| 1326286899 | Michelle Andaya Ziegler | Physical Therapist | 532 Tallent Ct, Ellsworth Afb, SD 57706-1717 | 2009-01-21 |
| 1528330081 | Marryanne Allen | Nurse Practitioner | 105 Red Cloud Ct, Ellsworth Afb, SD 57706-1724 | 2012-01-30 |
| 1710201553 | Ivan Vicente | Military Health Care Provider | 433 Black Elk Ct, Ellsworth Afb, SD 57706-1847 | 2010-03-23 |
| 1831539642 | Brendan Robert Cleary | Pediatrics | 28th Medical Group, Ellsworth Afb, 6000 Doolittle Drive, Rapid City, SD 57706-1873 | 2013-06-26 |
| 1922094671 | Scott Anthony Jones | Physical Therapist | 2450 Risner Dr, Ellsworth Afb, SD 57706-4704 | 2005-09-27 |
| 1174703144 | Michelle Renaee Haleck | Dietitian, Registered | 2450 Risner Dr, Ellsworth Air Force Base, Ellsworth Afb, SD 57706-4704 | 2007-11-07 |
| Find all providers in zip 57706 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033479688 | Jeffrey Robert Hartzell | Physician Assistant | 2900 Doolittle Dr, Ellsworth Afb, SD 57706-4821 | 2012-05-16 |
| 1609150168 | Brandy Elua Sande | Physician Assistant | 2900 Doolittle Dr, Ellsworth Afb, SD 57706-4821 | 2011-10-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831595545 | Kayla Weisbeck | Physician Assistant | 200 E Havens Ave, Mitchell, SD 57301-0432 | 2014-11-06 |
| 1306269287 | Prairie Community Health Inc. | Physician Assistant | 223 A Street, Dupree, SD 57623-9999 | 2014-01-28 |
| 1528392941 | Marilyn Margaret Roberts | Physician Assistant | Crhc, 24276 166th St, Airport Rd, Eagle Butte, SD 57625-1012 | 2009-10-01 |
| 1255516324 | Harding County Healthcare LLC | Physician Assistant | 209 Ramsland Street, Buffalo, SD 57720-0182 | 2008-01-08 |
| 1790972719 | Angela Blane Chambers | Physician Assistant | 161 S Main St., Mission, SD 57555 | 2007-10-03 |
| 1649348590 | Richard Dunn | Physician Assistant | Pine Ridge Hospital East Highway 18, Pine Ridge, SD 57770-1201 | 2006-11-30 |
| 1649368960 | Gary Neil Wurgler | Physician Assistant | 47226 S Rhonda Ave, Sioux Falls, SD 57108 | 2006-10-11 |
| 1558464446 | Douglas County Memorial Hospital | Physician Assistant | 301 Main Street, Stickney, SD 57375-0014 | 2006-09-06 |
| 1760493811 | Renette Lynne Kroupa | Physician Assistant | Hwy 34/47, Fort Thompson, SD 57339 | 2006-08-11 |
| 1356375992 | Ruth M Thomas | Physician Assistant | Soldier Creek Road,box 400, Rosebud Indian Health Service Hospital, Rosebud, SD 57570-0400 | 2006-07-10 |
| Find all providers with the same taxonomy | ||||
| City | ELLSWORTH AFB |
| Zip Code | 57706 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.