Provider Demographics
NPI:1609487933
Name:MANGRUM, ASHLEIGH CHASE (PA-C)
Entity type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:CHASE
Last Name:MANGRUM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8585 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-2817
Mailing Address - Country:US
Mailing Address - Phone:702-798-8585
Mailing Address - Fax:702-341-0109
Practice Address - Street 1:8585 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2817
Practice Address - Country:US
Practice Address - Phone:702-798-8585
Practice Address - Fax:702-341-0109
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ074386Medicaid
MS005306518Medicaid
MS09010261Medicaid