Basic Information
Provider Information
NPI: 1801339593
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FAUSNAUGH
FirstName: ASHLEY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4439 STATE ROUTE 159 STE 210
Address2:  
City: CHILLICOTHE
State: OH
PostalCode: 456018207
CountryCode: US
TelephoneNumber: 7407798530
FaxNumber: 7407798539
Practice Location
Address1: 4439 STATE ROUTE 159 STE 210
Address2:  
City: CHILLICOTHE
State: OH
PostalCode: 456018207
CountryCode: US
TelephoneNumber: 7407798530
FaxNumber: 7407798539
Other Information
ProviderEnumerationDate: 11/29/2016
LastUpdateDate: 12/24/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/24/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAPRN.CNP.020127OHY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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