Provider Demographics
NPI:1447439146
Name:PAULY, ASHLEIGH JAY (CRNA)
Entity type:Individual
Prefix:MS
First Name:ASHLEIGH
Middle Name:JAY
Last Name:PAULY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ASHLEIGH
Other - Middle Name:JAY
Other - Last Name:SUPPES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2897
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-2897
Mailing Address - Country:US
Mailing Address - Phone:800-374-5326
Mailing Address - Fax:800-374-7656
Practice Address - Street 1:929 N SAINT FRANCIS ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3821
Practice Address - Country:US
Practice Address - Phone:316-268-5322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1390943081163W00000X
KS55627367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200542180AMedicaid
KSP00605521OtherRR MEDICARE GROUPCQ2302
KSP00605521OtherRR MEDICARE GROUPCQ2302