MEDICARE: ASHLEY GAYLE VAUGHAN NURSE PRACTITIONER

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	363LP0200X	Pediatric Nurse Practitioner	A004321	AR

General Provider Information

NPI Number	:	1265824841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY GAYLE VAUGHAN NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	PO BOX 11017
Second Line	:	PEDIATRIC PARTNERS, P.A.
City	:	FORT SMITH
State	:	AR
Zip	:	72917-1017
Country	:	US
Telephone Number	:	479-478-7200
Fax Number	:	479-478-7225

Provider Business Practice Location Address
First Line	:	7303 ROGERS, AVE 201,
Second Line	:	PEDIATRIC PARTNERS
City	:	FORT SMITH
State	:	AR
Zip	:	72903-4112
Country	:	US
Telephone Number	:	479-478-7200
Fax Number	:	479-478-7225

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

Provider Enumeration Date	:	02/19/2015
Last Update Date	:	02/19/2015

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