Polly Sue Gockley, CRNP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

SP010356 Issued in PA

Practice address

1535 Highlands Dr Ste 100
Lititz, PA 17543-7681

Phone

(717) 627-4088

Fax

(717) 627-4089

NPI assigned

Jul 24, 2009

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1248393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1498780800000",
    "number": "1912137886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 S 2ND ST STE 2F",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171041612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1535 HIGHLANDS DR STE 100",
            "city": "LITITZ",
            "state": "PA",
            "postal_code": "175437681",
            "telephone_number": "717-627-4088",
            "fax_number": "717-627-4089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOCKLEY",
        "first_name": "POLLY",
        "middle_name": "SUE",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-24",
        "last_updated": "2017-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "PA",
            "license": "SP010356",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1024288560002",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heather L Girdharry, DO
• Tyrone D Girdharry, MD
• Margaret M Girten, RD, LDN, FAND
• Caleb Gish
• Kimberly Kay Gleason-Hink, MA,PT
• Christopher Godshall, LMT
• Karen Good
• James Gotwald
• John Talmage Gotwalt, D.D.S., FAGD
• Jennifer Graham, DPT

• Adult Health Nurse Practitioner in Lititz, PA
• Providers in Lititz, PA by specialty
• Adult Health Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.