Provider Demographics
NPI:1003362617
Name:AYRES, JULIANA (PMHNP)
Entity Type:Individual
Prefix:
First Name:JULIANA
Middle Name:
Last Name:AYRES
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:JULIANA
Other - Middle Name:MCCLINTOCK
Other - Last Name:AYRES DOHERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:190 OAK ST APT 4
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1886
Mailing Address - Country:US
Mailing Address - Phone:541-422-3851
Mailing Address - Fax:541-325-4827
Practice Address - Street 1:190 OAK ST APT 4
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1886
Practice Address - Country:US
Practice Address - Phone:541-422-3851
Practice Address - Fax:541-325-4827
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2018004137363LP0808X
OR201802512NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR201802512NP-PPOtherPMHNP LISCENSE NUMBER