Provider Demographics
NPI:1114291374
Name:GURWELL, LANDY (PA-C)
Entity type:Individual
Prefix:
First Name:LANDY
Middle Name:
Last Name:GURWELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LANDY
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1470
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78853-1470
Mailing Address - Country:US
Mailing Address - Phone:830-773-8917
Mailing Address - Fax:830-773-8917
Practice Address - Street 1:2525 N VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-3302
Practice Address - Country:US
Practice Address - Phone:830-773-5358
Practice Address - Fax:830-773-0258
Is Sole Proprietor?:No
Enumeration Date:2012-03-05
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07619363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA07619OtherTX PHYSICIAN ASSISTANT LICENSE
TX1098827OtherNCCPA