Doctor Name: | ELLEN VAUGHAN |
NPI Number: | 1215082680 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 097001 |
Business Practice Address: | 610 N. One Mile Road Dexter, MO - 63841 |
Business Phone Number: | 5736243600 |
Business Fax Number: | |
Mailing Address: | 10492 State Highway Zz, DEXTER |
State: | MO |
Postal Code: | 63841 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 01/24/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 097001 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |