| Doctor Name: | JUDY GOURLEY |
| NPI Number: | 1740686047 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | LOOO602 |
| Business Practice Address: | 2204 Wilborn Ave South Boston, VA - 245921645 |
| Business Phone Number: | 4345173579 |
| Business Fax Number: | |
| Mailing Address: | 2204 Wilborn Ave, SOUTH BOSTON |
| State: | VA |
| Postal Code: | 245921645 |
| Phone Number: | 4345173579 |
| Fax Number: | |
| NPI Enumeration Date: | 11/13/2014 |
| NPI Last Update Date: | 11/17/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | LOOO602 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NC |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |