Active NPI
Judy Gourley
- Registered Dietitian
- South Boston, VA
National Provider Identifier
1740686047
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 613615
- Practice address
- 2204 Wilborn Ave
South Boston, VA 24592-1645 - Phone
- (434) 517-3579
- NPI assigned
- Nov 13, 2014
- Last updated
- Nov 17, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 613615 | VA | Primary |
| Registered Dietitian | 133V00000X | LOOO602 | NC |
Addresses
Primary practice location
2204 Wilborn Ave
South Boston, VA 24592-1645
Mailing address
2204 Wilborn Ave
South Boston, VA 24592-1645
Phone (434) 517-3579
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LOOO602 | NC | MD | Registered Dietitian |
| 613615 | VA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1415836800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1416182400000",
"number": "1740686047",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2204 WILBORN AVE",
"city": "SOUTH BOSTON",
"state": "VA",
"postal_code": "245921645",
"telephone_number": "434-517-3579"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2204 WILBORN AVE",
"city": "SOUTH BOSTON",
"state": "VA",
"postal_code": "245921645",
"telephone_number": "434-517-3579"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOURLEY",
"first_name": "JUDY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-11-13",
"last_updated": "2014-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "VA",
"license": "613615",
"primary": true
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NC",
"license": "LOOO602",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Boston, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.