Provider Demographics
NPI:1780495077
Name:GAUGHAN, KARLEY B (APRN, NP)
Entity type:Individual
Prefix:
First Name:KARLEY
Middle Name:B
Last Name:GAUGHAN
Suffix:
Gender:
Credentials:APRN, NP
Other - Prefix:
Other - First Name:KARLEY
Other - Middle Name:B
Other - Last Name:BEAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7008 E 700 N
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:IN
Mailing Address - Zip Code:46162-9736
Mailing Address - Country:US
Mailing Address - Phone:317-965-9062
Mailing Address - Fax:
Practice Address - Street 1:1701 N SENATE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5306
Practice Address - Country:US
Practice Address - Phone:317-963-0174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-15
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71016225A363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care