Individual provider · Type 1 NPI

Samuel Addison Gulley, PA-S

Student in an Organized Health Care Education/Training Program · Fort Campbell, KY

NPI number 1114718905 Active

Practice location

650 Joel Dr
Fort Campbell, KY 42223-5318

Call (270) 956-0336 Map

Specialties and licenses

TaxonomyCodeLicense
Physician Assistant 363A00000XNone listed
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed
Military Health Care Provider 171000000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1114718905

Samuel Addison Gulley, PA-S's National Provider Identifier is 1114718905, issued on May 13, 2025. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Fort Campbell, KY. The record was last updated on May 13, 2025.