Provider Demographics
NPI:1972365781
Name:GOURLEY, REID (RN)
Entity type:Individual
Prefix:
First Name:REID
Middle Name:
Last Name:GOURLEY
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 SERENITAS LN
Mailing Address - Street 2:
Mailing Address - City:GOFFSTOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03045-2922
Mailing Address - Country:US
Mailing Address - Phone:603-860-9657
Mailing Address - Fax:
Practice Address - Street 1:218 EAST RD
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NH
Practice Address - Zip Code:03841-5303
Practice Address - Country:US
Practice Address - Phone:603-329-5311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-26
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH065551-21163WP0807X, 163WP0808X
NH065551-23363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health