Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | A005761 | AR |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | A005761 | AR |
NPI | 1073159984 |
---|---|
Provider Name | Angel Gulley |
First Address | Marion, AR 72364-9004 |
Second Address | Marion, AR 72364 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2019 |
Last Update Date | 30/11/2021 |