Provider Demographics
NPI:1871515866
Name:GURLEY, BETH (PA-C)
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:
Last Name:GURLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:765 HIGHLAND OAKS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-7101
Mailing Address - Country:US
Mailing Address - Phone:336-760-4004
Mailing Address - Fax:336-760-6632
Practice Address - Street 1:2515 LEWISVILLE CLEMMONS RD
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8712
Practice Address - Country:US
Practice Address - Phone:336-979-4499
Practice Address - Fax:336-355-7505
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC103453363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8978751Medicaid
NCMG0842155OtherDEA
NCMG0842155OtherDEA
NC8978751Medicaid