Provider Demographics
NPI:1265824841
Name:VAUGHAN, ASHLEY GAYLE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:GAYLE
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 11017
Mailing Address - Street 2:PEDIATRIC PARTNERS, P.A.
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-1017
Mailing Address - Country:US
Mailing Address - Phone:479-478-7200
Mailing Address - Fax:479-478-7225
Practice Address - Street 1:7303 ROGERS, AVE 201,
Practice Address - Street 2:PEDIATRIC PARTNERS
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4112
Practice Address - Country:US
Practice Address - Phone:479-478-7200
Practice Address - Fax:479-478-7225
Is Sole Proprietor?:No
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARA004321363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics