| Doctor Name: | MISS KIMARA VAUGHN |
| NPI Number: | 1003068727 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN-BC |
| License Number: | AP3147 |
| Business Practice Address: | 2770 E Van Buren St Phoenix, AZ - 850086088 |
| Business Phone Number: | 6022739999 |
| Business Fax Number: | |
| Mailing Address: | 4045 E Bell Rd, Suite 111 PHOENIX |
| State: | AZ |
| Postal Code: | 850322236 |
| Phone Number: | 6026062658 |
| Fax Number: | 6024287003 |
| NPI Enumeration Date: | 10/13/2008 |
| NPI Last Update Date: | 03/08/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | AP3147 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |