Provider Demographics
NPI:1104115153
Name:GURLEY, CONNIE LYNNE (APRN-BC, FNP)
Entity type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:LYNNE
Last Name:GURLEY
Suffix:
Gender:F
Credentials:APRN-BC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 728
Mailing Address - Street 2:
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-0728
Mailing Address - Country:US
Mailing Address - Phone:573-888-8690
Mailing Address - Fax:573-717-1085
Practice Address - Street 1:1231 1ST ST
Practice Address - Street 2:SUITE 5
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-2527
Practice Address - Country:US
Practice Address - Phone:573-888-8690
Practice Address - Fax:573-717-1085
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011011192363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily