Provider Demographics
NPI:1548365133
Name:GULLEY, ANITA LEE (APRN)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:LEE
Last Name:GULLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 MEDICAL CIR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1194
Mailing Address - Country:US
Mailing Address - Phone:606-780-5500
Mailing Address - Fax:606-783-7281
Practice Address - Street 1:245 FLEMINGSBURG RD
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1015
Practice Address - Country:US
Practice Address - Phone:606-780-5500
Practice Address - Fax:606-783-7281
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004656363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0213365OtherMEDICARE ID - 2133
KY0074290OtherMEDICARE ID - 8002
KY0216377OtherMEDICARE ID - 2163
KY78015815Medicaid
KY1063391OtherMEDICARE ID - 0633
KY0247263OtherMEDICARE ID - 8158
KYQ51434Medicare UPIN