Healthcare Provider Details

I. General information

NPI: 1952738387
Provider Name (Legal Business Name): ASHLEY L. AYLWARD BADGLEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2013
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 YELLOWSTONE RD
CHEYENNE WY
82009-4741
US

IV. Provider business mailing address

PO BOX 20970
CHEYENNE WY
82003-7020
US

V. Phone/Fax

Practice location:
  • Phone: 307-632-1114
  • Fax: 307-632-9920
Mailing address:
  • Phone: 307-632-9261
  • Fax: 307-634-9170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number5489
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA642
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: