Amber P Gourley, RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

2620 Issued in TN

Practice address

444 Clinchfield St Ste 201
Kingsport, TN 37660-3863

Phone

(423) 230-2113

Fax

(423) 230-2112

NPI assigned

Aug 7, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Specialty

Registered Dietitian Or Nutrition Professional

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Heal U, LLC

  • Registered Dietitian
  • Johnson City, TN
  • NPI 1396219341

  Dietitian, Registered

  Medicare reassignment NPD Authorized official
• East Tennessee State University

  • Federally Qualified Health Center (FQHC)
  • Johnson City, TN
  • NPI 1477660199
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1375833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538611200000",
    "number": "1760814271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2866 CARROLL CREEK RD",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376154541",
            "telephone_number": "423-439-4071",
            "fax_number": "423-439-4060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "444 CLINCHFIELD ST STE 201",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376603863",
            "telephone_number": "423-230-2113",
            "fax_number": "423-230-2112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOURLEY",
        "first_name": "AMBER",
        "middle_name": "P",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-07",
        "last_updated": "2018-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "TN",
            "license": "2620",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ST LIC",
            "identifier": "2620",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• George Daniel Gonzalez, M.D.
• Sherry Lynn Goode, NP
• Jami Nacole Goodwin, M.D.
• Ryan Wesley Gordon, M.D.
• Natasha Benfield Gouge, PHD
• Grace Care Pharmacy
• Brittany Nicole Graham Dockery, LPN
• Amanda Nicole Graham, LPTA
• Tina Renee Graham, FNP
• Alli Quinn Gray, FNP

• Registered Dietitian in Kingsport, TN
• Providers in Kingsport, TN by specialty
• Registered Dietitian in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.