MEDICARE: MRS. ASHLEY RAEDEANE BAUREIS APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	230456	AR

General Provider Information

NPI Number	:	1043046261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ASHLEY RAEDEANE BAUREIS APRN

Provider Business Mailing Address
First Line	:	2225 HIGHWAY 110 W
Second Line	:
City	:	HEBER SPRINGS
State	:	AR
Zip	:	72543-3404
Country	:	US
Telephone Number	:	501-362-0048
Fax Number	:

Provider Business Practice Location Address
First Line	:	2225 HIGHWAY 110 W
Second Line	:
City	:	HEBER SPRINGS
State	:	AR
Zip	:	72543-3404
Country	:	US
Telephone Number	:	501-362-0048
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2024
Last Update Date	:	09/12/2024

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