Provider Demographics
NPI:1720058183
Name:GOURLEY, LANA KAY (PA)
Entity type:Individual
Prefix:
First Name:LANA
Middle Name:KAY
Last Name:GOURLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 268838
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8838
Mailing Address - Country:US
Mailing Address - Phone:918-660-3632
Mailing Address - Fax:918-660-3631
Practice Address - Street 1:4444 E 41ST ST
Practice Address - Street 2:3RD FLOOR, STE B
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2527
Practice Address - Country:US
Practice Address - Phone:918-582-0721
Practice Address - Fax:918-582-4751
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2007-08-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK237363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant