Healthcare Provider Details

I. General information

NPI: 1316552946
Provider Name (Legal Business Name): MADELYNN LEA OGLESBY PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3317 S HIGLEY RD
GILBERT AZ
85297-5436
US

IV. Provider business mailing address

3295 E CASTANETS DR
GILBERT AZ
85298-9189
US

V. Phone/Fax

Practice location:
  • Phone: 480-900-8639
  • Fax:
Mailing address:
  • Phone: 602-663-2776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9128
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-320361
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: