Individual
ASHLEIGH CHASE MANGRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8585 S EASTERN AVE, LAS VEGAS, NV 89123-2817
(702) 798-8585
(702) 341-0109
Mailing address
8585 S EASTERN AVE, LAS VEGAS, NV 89123-2817
(702) 798-8585
(702) 341-0109
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005306518
—
MS
05
—
09010261
—
MS
05
—
Q074386
—
TN
Enumeration date
08/11/2020
Last updated
07/17/2024
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