Individual
TERRY LEE GOURLEY
Active
Individual
TERRY LEE GOURLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
1151
SD
363AM0700X
Medical Physician Assistant
Primary
1151
SD
363AM0700X
Medical Physician Assistant
866
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1029358
NCCPA CERT
SD
01
—
866
LICENSE
NE
Enumeration date
02/28/2007
Last updated
03/27/2026
Update your record
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