Provider Demographics
NPI:1952738387
Name:AYLWARD BADGLEY, ASHLEY L (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:L
Last Name:AYLWARD BADGLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20970
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-7020
Mailing Address - Country:US
Mailing Address - Phone:307-632-9261
Mailing Address - Fax:307-634-9170
Practice Address - Street 1:5201 YELLOWSTONE RD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4741
Practice Address - Country:US
Practice Address - Phone:307-632-1114
Practice Address - Fax:307-632-9920
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
AZ5489363AS0400X
WYPA642363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ895979Medicaid
AZZ166994Medicare PIN