Provider Demographics
NPI:1740172741
Name:GAUGHAN, JUDE MARY
Entity type:Individual
Prefix:
First Name:JUDE
Middle Name:MARY
Last Name:GAUGHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W BENSON BLVD STE 306
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3936
Mailing Address - Country:US
Mailing Address - Phone:907-885-1089
Mailing Address - Fax:
Practice Address - Street 1:101 W BENSON BLVD STE 306
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3936
Practice Address - Country:US
Practice Address - Phone:907-885-1089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK235897363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health