1265824841 NPI number — ASHLEY GAYLE VAUGHAN NURSE PRACTITIONER

Table of content: ASHLEY GAYLE VAUGHAN NURSE PRACTITIONER (NPI 1265824841)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265824841 NPI number — ASHLEY GAYLE VAUGHAN NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAUGHAN
Provider First Name:
ASHLEY
Provider Middle Name:
GAYLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265824841
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11017
Provider Second Line Business Mailing Address:
PEDIATRIC PARTNERS, P.A.
Provider Business Mailing Address City Name:
FORT SMITH
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72917-1017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-478-7200
Provider Business Mailing Address Fax Number:
479-478-7225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7303 ROGERS, AVE 201,
Provider Second Line Business Practice Location Address:
PEDIATRIC PARTNERS
Provider Business Practice Location Address City Name:
FORT SMITH
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72903-4112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-478-7200
Provider Business Practice Location Address Fax Number:
479-478-7225
Provider Enumeration Date:
02/19/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  A004321 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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